Provider Demographics
NPI:1316003692
Name:CHANG, STILLMAN (MD)
Entity Type:Individual
Prefix:
First Name:STILLMAN
Middle Name:
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 1:800 BIESTERFIELD RD
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3311
Mailing Address - Country:US
Mailing Address - Phone:847-495-1603
Mailing Address - Fax:847-537-4866
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-495-1603
Practice Address - Fax:847-537-4866
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064737 1Medicaid
IL0161919966OtherBLUE SHIELD
ILL25256Medicare PIN
IL036064737 1Medicaid