Provider Demographics
NPI:1023075603
Name:CHANG, AUDREY (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:GIANGIORGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:346 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2506
Mailing Address - Country:US
Mailing Address - Phone:847-234-9644
Mailing Address - Fax:
Practice Address - Street 1:1525 W BELMONT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7176
Practice Address - Country:US
Practice Address - Phone:773-880-1738
Practice Address - Fax:773-472-7395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H95855Medicare UPIN