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General NPI Number Information
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NPI Number | 1609932417
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Entity Type | Individual
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Provider Name | BOONCHOO CHANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 417 W HIGH ST
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City | DOWAGIAC
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State | MI
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Zip | 49047-1906
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Country | US
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Telephone | 269-782-7150
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Fax | 269-782-7020
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Provider Business Mailing Address
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Address Line | 417 W HIGH ST
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City | DOWAGIAC
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State | MI
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Zip | 49047-1906
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Country | US
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Telephone | 269-782-7150
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Fax | 269-782-7020
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 4301031400
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 4301031400
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License Number State | MI
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