Provider Demographics
NPI:1770695793
Name:CHANG, STEPHEN Y (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Y
Last Name:CHANG
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE #1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8709
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-0050
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER 17-250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-5620
Practice Address - Fax:312-695-7095
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036106945207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106945Medicaid
ILP00461420OtherRAILROAD MEDICARE