Healthcare Provider Details

I. General information

NPI: 1831175942
Provider Name (Legal Business Name): BASIL TZU LI CHANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W MAIN STREET
WILMINGTON OH
45177-0000
US

IV. Provider business mailing address

610 W MAIN STREET
WILMINGTON OH
45177-0000
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-2246
  • Fax: 513-865-5552
Mailing address:
  • Phone: 513-865-2246
  • Fax: 513-865-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1249
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12686
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.012490
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberO-0638
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1249
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.012490
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: