Provider Demographics
NPI:1710220744
Name:CHANG, ERIC KIRTWEI (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KIRTWEI
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 1:201 S 1ST ST APT 424
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1754
Mailing Address - Country:US
Mailing Address - Phone:630-947-2317
Mailing Address - Fax:
Practice Address - Street 1:8402 HARCOURT RD STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2052
Practice Address - Country:US
Practice Address - Phone:317-338-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011092892080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology