Provider Demographics
NPI:1225099781
Name:CHANG, ATTICA C (MD)
Entity Type:Individual
Prefix:
First Name:ATTICA
Middle Name:C
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 NW BOCA RATON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1609
Mailing Address - Country:US
Mailing Address - Phone:561-395-9500
Mailing Address - Fax:561-395-9234
Practice Address - Street 1:1356 NW BOCA RATON BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1609
Practice Address - Country:US
Practice Address - Phone:561-395-9500
Practice Address - Fax:561-395-9234
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15896OtherBCBS
FL030455341OtherTAX ID#
FLH48130Medicare UPIN
FL030455341OtherTAX ID#