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General NPI Number Information
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NPI Number | 1023075603
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Entity Type | Individual
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Provider Name | AUDREY CHANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1525 W BELMONT AVE SUITE 103
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City | CHICAGO
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State | IL
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Zip | 60657-7176
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Country | US
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Telephone | 773-880-1738
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Fax | 773-472-7395
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Provider Business Mailing Address
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Address Line | 346 E CENTER AVE
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City | LAKE BLUFF
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State | IL
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Zip | 60044-2506
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Country | US
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Telephone | 847-234-9644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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