MEDICARE: CHARLES S 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	207T00000X	Neurological Surgery Physician	206001	MA
2	207T00000X	Neurological Surgery Physician	11048	NH
3	207T00000X	Neurological Surgery Physician	H3003	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1023240751	OTHER	TX	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	H3003	OTHER	TX	TX LICENSE #
4	8CC790	OTHER	TX	BLUE CROSS PROVIDER NUMBER

General Provider Information

NPI Number	:	1659364412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES S CHANG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 262449
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-2449
Country	:	US
Telephone Number	:	214-778-2530
Fax Number	:	214-778-2542

Provider Business Practice Location Address
First Line	:	4001 W 15TH ST
Second Line	:	SUITE 260
City	:	PLANO
State	:	TX
Zip	:	75093-5841
Country	:	US
Telephone Number	:	214-778-2530
Fax Number	:	214-778-2542

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	01/23/2012

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Directions to “ CHARLES S CHANG M.D.” Practice Location

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