Basic Information
| Provider Information | |||||||||
| NPI: | 1023075603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GIANGIORGI | ||||||||
| OtherFirstName: | AUDREY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 346 E CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600442506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472349644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1525 W BELMONT AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606577176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738801738 | ||||||||
| FaxNumber: | 7734727395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.