Healthcare Provider Details

I. General information

NPI: 1598807547
Provider Name (Legal Business Name): ZONGLI CHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17880 FARMINGTON RD
LIVONIA MI
48152-3104
US

IV. Provider business mailing address

17880 FARMINGTON RD
LIVONIA MI
48152-3104
US

V. Phone/Fax

Practice location:
  • Phone: 734-266-8036
  • Fax: 734-266-8038
Mailing address:
  • Phone: 734-266-8036
  • Fax: 734-266-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301087633
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301087633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: