Provider Demographics
NPI:1134979537
Name:CHANG, CHRISTOPHER DANIEL (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DANIEL
Last Name:CHANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ST. ELIZABETH BLVD.
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:O'FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-222-4701
Mailing Address - Fax:844-458-1916
Practice Address - Street 1:3 ST. ELIZABETH'S BLVD.
Practice Address - Street 2:SUITE 400
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-233-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program