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NPI Code Detail

MEDICARE: INGRID CHANG MD

MEDICARE: INGRID CHANG MD
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
1207RN0300XNephrology PhysicianMD39231TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00429346OTHERCORR MEDICARE

General Provider Information

NPI Number : 1124110549
Entity Type Code : Individual
Provider Name (Legal Business Name) : INGRID CHANG MD
Provider Business Mailing Address
First Line : 4891 INDEPENDENCE ST
Second Line : SUITE 120
City : WHEAT RIDGE
State : CO
Zip : 80033-6752
Country : US
Telephone Number : 303-456-5495
Fax Number : 303-456-7490
Provider Business Practice Location Address
First Line : 8410 DECATUR ST
Second Line :
City : WESTMINSTER
State : CO
Zip : 80031-3811
Country : US
Telephone Number : 303-430-7000
Fax Number : 303-430-1506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2006
Last Update Date : 10/22/2008

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Directions to “ INGRID CHANG MD” Practice Location

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