Provider Demographics
NPI:1184925265
Name:RICHARD L. CHANG PA
Entity type:Organization
Organization Name:RICHARD L. CHANG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-270-8083
Mailing Address - Street 1:10820 SW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3227
Mailing Address - Country:US
Mailing Address - Phone:305-270-8083
Mailing Address - Fax:305-271-5223
Practice Address - Street 1:10820 SW 113TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3227
Practice Address - Country:US
Practice Address - Phone:305-270-8083
Practice Address - Fax:305-271-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 59505207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0767450001Medicare NSC
FL12437Medicare PIN
FLE89689Medicare UPIN