Provider Demographics
NPI:1578524831
Name:CHANG, ILWOONG W (MD)
Entity Type:Individual
Prefix:DR
First Name:ILWOONG
Middle Name:W
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9030 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2905
Mailing Address - Country:US
Mailing Address - Phone:219-836-6002
Mailing Address - Fax:219-836-6003
Practice Address - Street 1:9030 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2905
Practice Address - Country:US
Practice Address - Phone:219-836-6002
Practice Address - Fax:219-836-6003
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01026031A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC25015Medicare UPIN