Individual
LAURETTE CHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8335
(765) 448-7656
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
01061088A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000372021
ANTHEM PROVIDER NUMBER
IN
01
—
10706379
CAQH NUMBER
IN
05
—
200530930
—
IN
01
—
9286866
PHCS PID NUMBER
IN
Enumeration date
03/15/2006
Last updated
10/12/2007
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