MEDICARE: COLIN E. CHANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01045412A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114922986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN E. CHANG M.D.

Provider Business Mailing Address
First Line	:	550 S LANDMARK AVE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-3239
Country	:	US
Telephone Number	:	812-355-2300
Fax Number	:	812-355-2316

Provider Business Practice Location Address
First Line	:	2605 E. CREEK'S EDGE DR.
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401
Country	:	US
Telephone Number	:	812-355-2300
Fax Number	:	812-355-2316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/12/2016

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Directions to “ COLIN E. CHANG M.D.” Practice Location

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