Provider Demographics
NPI:1558361048
Name:CHANG, FONG MEI (MD)
Entity Type:Individual
Prefix:DR
First Name:FONG
Middle Name:MEI
Last Name: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 1:14153 YOSEMITE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6575
Mailing Address - Country:US
Mailing Address - Phone:727-868-5404
Mailing Address - Fax:727-863-1787
Practice Address - Street 1:14153 YOSEMITE DR STE 202
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-868-5404
Practice Address - Fax:727-863-1787
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035346207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063823400Medicaid
FL51111Medicare ID - Type Unspecified