Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 27817 | OK |
NPI | 1285744045 |
---|---|
Provider Name | Michael Lee Chang |
First Address | Tulsa, OK 74136-3347 |
Second Address | Tulsa, OK 74136-1907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 19/05/2011 |