| Doctor Name: | DR. BOONCHOO CHANG |
| NPI Number: | 1609932417 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301031400 |
| Business Practice Address: | 417 W High St Dowagiac, MI - 490471906 |
| Business Phone Number: | 2697827150 |
| Business Fax Number: | 2697827020 |
| Mailing Address: | 417 W High St, DOWAGIAC |
| State: | MI |
| Postal Code: | 490471906 |
| Phone Number: | 2697827150 |
| Fax Number: | 2697827020 |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 12/28/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 4301031400 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |