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General NPI Number Information
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NPI Number | 1750606448
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Entity Type | Individual
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Provider Name | LILLY CHANG
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Gender | Female
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 501 6TH AVE S DEPARTMENT 6590170301
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4634
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Country | US
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Telephone | 352-273-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 700 DOCKVIEW WAY APT 1421
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City | TAMPA
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State | FL
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Zip | 33602-6734
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Country | US
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Telephone | 813-849-3147
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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 | ME117162
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License Number State | FL
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