Provider Demographics
NPI:1477666394
Name:CHANG, HARK (MD)
Entity Type:Individual
Prefix:DR
First Name:HARK
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:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1105
Mailing Address - Country:US
Mailing Address - Phone:618-549-5361
Mailing Address - Fax:618-549-5128
Practice Address - Street 1:2601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1031
Practice Address - Country:US
Practice Address - Phone:618-549-5361
Practice Address - Fax:618-549-5128
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110494208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110494Medicaid
IL630411OtherHEALTHLINK INSURANCE NUMB
IL7210895OtherAETNA
IL088959OtherHAMP INSURANCE NUMBER
ILP00088940OtherRR MEDICARE NUMBER
IL3932056OtherBCBS OF IL.
IL196221OtherGHP INSURANCE NUMBER
IL324123OtherGHP
ILK04830Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
IL7210895OtherAETNA
IL614350Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL3932056OtherBCBS OF IL.
IL214881Medicare PIN