Organization
MARK K CHANG MD
Active
Other names
MIDWEST SPINECARE
Organization subpart
No
Provider details
NPI number
Authorized official
MARK K CHANG MD (MEDICAL DIRECTOR)
(219) 836-4955
Entity
Organization
Contact information
Practice address
1100 JOLIET ST, SUITE 104, DYER, IN 46311-1996
(219) 836-4955
Mailing address
1100 JOLIET ST, SUITE 104, DYER, IN 46311-1996
(219) 836-4955
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
036095817
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03609507
—
IL
01
—
5930340001
RR MEDICARE
IL
Enumeration date
05/28/2008
Last updated
01/12/2015
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