Provider Demographics
NPI:1902809601
Name:CHANG-STROMAN, TAE'NI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAE'NI
Middle Name:
Last Name:CHANG-STROMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 JOLIET ST
Mailing Address - Street 2:STE 103
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1925
Mailing Address - Country:US
Mailing Address - Phone:219-322-8534
Mailing Address - Fax:219-865-9072
Practice Address - Street 1:1160 JOLIET ST
Practice Address - Street 2:STE 103
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1925
Practice Address - Country:US
Practice Address - Phone:219-322-8534
Practice Address - Fax:219-865-9072
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90001231OtherBCBSIL PROVIDER ID
IN000000365599OtherANTHEM PROVIDER ID
IN100463430BMedicaid
10780906OtherCAQH
IN000000365599OtherANTHEM PROVIDER ID
32-0149967OtherEIN