Provider Demographics
NPI:1992946974
Name:ATTICA CHANG MD PA
Entity type:Organization
Organization Name:ATTICA CHANG MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ATTICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-395-9500
Mailing Address - Street 1:1356 NW BOCA RATON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1609
Mailing Address - Country:US
Mailing Address - Phone:561-395-9500
Mailing Address - Fax:561-395-9234
Practice Address - Street 1:1356 NW BOCA RATON BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1609
Practice Address - Country:US
Practice Address - Phone:561-395-9500
Practice Address - Fax:561-395-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15896OtherBCBS
FLH48130Medicare UPIN
FL15896OtherBCBS