Provider Demographics
NPI:1477538510
Name:CHANG, MICHAEL CHI-MING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHI-MING
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DRIVE, MASTIN 101
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-445-8282
Practice Address - Fax:251-445-8481
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400747208600000X, 2086S0102X, 2086S0127X
ALMD.140812086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4602529OtherAETNA
NC6590OtherPARTNERS
NC51284OtherMEDCOST
SCQ0074EMedicaid
NC22049OtherBLUE CROSS
WV221986000Medicaid
NC8922049Medicaid
VA7302185Medicaid
NC22049OtherBLUE CROSS
SCQ0074EMedicaid