Provider Demographics
NPI:1891775250
Name:CHANG, ROGER KAI-DI (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:KAI-DI
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 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-707-4041
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:2055 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1946
Practice Address - Country:US
Practice Address - Phone:513-732-0870
Practice Address - Fax:513-732-0873
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38086413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272535Medicaid
OH2272535Medicaid
OHCH2026221Medicare PIN