Tae'Ni Chang-Stroman, M.D.
Individual provider Active NPI Pediatrics Physician · Dyer, IN
NPI 1902809601 · NPPES record last updated Apr 30, 2015
Key facts
- NPI
- 1902809601
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 01042969 (IN)
- Practice address
- 1160 Joliet St
Ste 103
Dyer, IN 46311-1925 - Phone
- (219) 322-8534
- Fax
- (219) 865-9072
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01042969 | IN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tae'Ni Chang-Stroman M.D., P.C. | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- drtaenichang-stroman@kidsfirst.opdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01042969 | IN | Yes |
Addresses
Primary practice location
1160 Joliet St
Ste 103
Dyer, IN 46311-1925
Mailing address
1160 Joliet St
Ste 103
Dyer, IN 46311-1925
Phone (219) 322-8534
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90001231 | Other | IL | BCBSIL PROVIDER ID |
| 000000365599 | Other | IN | ANTHEM PROVIDER ID |
| 100463430B | Medicaid | IN | |
| 10780906 | Other | CAQH |
Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.