Provider Demographics
NPI:1255487138
Name:TAE'NI CHANG-STROMAN M.D., P.C.
Entity Type:Organization
Organization Name:TAE'NI CHANG-STROMAN M.D., P.C.
Other - Org Name:KIDS FIRST PEDIATRICS ON 30
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE'NI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG-STROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-322-8534
Mailing Address - Street 1:1160 JOLIET ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2096
Mailing Address - Country:US
Mailing Address - Phone:219-322-8534
Mailing Address - Fax:219-865-9072
Practice Address - Street 1:1160 JOLIET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2096
Practice Address - Country:US
Practice Address - Phone:219-322-8534
Practice Address - Fax:219-865-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty