Provider Demographics
NPI:1497954879
Name:CHANG, PHILIP CHI-LUEN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:CHI-LUEN
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 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:561-733-4400
Mailing Address - Fax:561-733-5004
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:BLDG. A, STE 760
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3724
Practice Address - Country:US
Practice Address - Phone:561-733-4400
Practice Address - Fax:561-733-5004
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278747400Medicaid