Provider Demographics
NPI:1295897569
Name:CHANG, STEVE I (MD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:I
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4555 W SCHROEDER DR
Mailing Address - Street 2:#170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1475
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3210
Practice Address - Street 1:12555 W NATIONAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:262-754-2555
Practice Address - Fax:262-754-2552
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32383100Medicaid
G47647Medicare UPIN
WI32383100Medicaid
WI000068343Medicare PIN