Provider Demographics
NPI:1295833259
Name:PALACIO-CHANG, ADORACION A (MD)
Entity Type:Individual
Prefix:DR
First Name:ADORACION
Middle Name:A
Last Name:PALACIO-CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39880 VAN DYKE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4668
Mailing Address - Country:US
Mailing Address - Phone:586-264-1030
Mailing Address - Fax:586-264-1031
Practice Address - Street 1:39880 VAN DYKE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4668
Practice Address - Country:US
Practice Address - Phone:586-264-1030
Practice Address - Fax:586-264-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAP032345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID91374Medicare UPIN
MI0500415Medicare PIN