Provider Demographics
NPI:1003390089
Name:CHANG, JULIE (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0489
Mailing Address - Country:US
Mailing Address - Phone:708-862-7674
Mailing Address - Fax:
Practice Address - Street 1:3749 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2019
Practice Address - Country:US
Practice Address - Phone:708-422-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant