Provider Demographics
NPI:1790055291
Name:CHANG, OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
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 1:1300 S MIAMI AVE UNIT 2301
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4478
Mailing Address - Country:US
Mailing Address - Phone:713-859-5709
Mailing Address - Fax:305-675-5854
Practice Address - Street 1:3659 S MIAMI AVE STE 4002
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4231
Practice Address - Country:US
Practice Address - Phone:305-915-4663
Practice Address - Fax:305-675-5854
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0888207P00000X
390200000X
FLME1167142086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program