Healthcare Provider Details

I. General information

NPI: 1558549428
Provider Name (Legal Business Name): CHENG ZHANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

700 ACKERMAN RD SUITE 570
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax: 937-325-3713
Mailing address:
  • Phone: 614-293-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35122295
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2012007487
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number238039
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: