Provider Demographics
NPI:1134121189
Name:CHANG, KAREN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ELIZABETH
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8890 N UNION BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2701
Mailing Address - Country:US
Mailing Address - Phone:719-364-5005
Mailing Address - Fax:719-365-9911
Practice Address - Street 1:8890 N UNION BLVD
Practice Address - Street 2:STE 170
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7799
Practice Address - Country:US
Practice Address - Phone:719-572-5005
Practice Address - Fax:719-572-5551
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074258207R00000X
CODR-49665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04839871Medicaid
FL255227200Medicaid
FL44450OtherBCBS
FL201841070OtherTAX ID
CO04839871Medicaid