Mark K Chang MD

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

036095817 Issued in IL

Legal business name

MARK K CHANG MD

Practice address

1100 Joliet St
Ste 104
Dyer, IN 46311-1996

Phone

(219) 836-4955

Fax

(219) 865-2377

NPI assigned

May 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark K. Chang, MD

Title

Medical Director

Phone

(219) 836-4955

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Midwest SpineCare, SC Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mark K Chang, M.D.

  • Orthopaedic Surgery Physician
  • Dyer, IN
  • NPI 1871607507

  O20100930082604

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1003022476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 JOLIET ST",
            "address_2": "STE 104",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111996",
            "telephone_number": "219-836-4955",
            "fax_number": "219-865-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 JOLIET ST",
            "address_2": "STE 104",
            "city": "DYER",
            "state": "IN",
            "postal_code": "463111996",
            "telephone_number": "219-836-4955",
            "fax_number": "219-865-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK K CHANG MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "219-836-4955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "IL",
            "license": "036095817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200868870A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DG1633",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest SpineCare, SC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christy Lynn Marcotte, PHARMD
• Gary A Marcotte, DO
• Sandra B Marcotte, DO
• Trevor J Marcotte, DO
• Milan Marinkovich Jr.
• Mark K Chang MD
• Maria Marrero, NP
• Lynnette Martin-Richey
• Sarah K Martinez, DPT
• Marvin L. Holloman

• Orthopaedic Surgery of the Spine Physician in Dyer, IN
• Providers in Dyer, IN by specialty
• Orthopaedic Surgery of the Spine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.