Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 4301091413 | MI |
Y | 207RA0201X | Internist - Allergy & Immunology | 4301091413 | MI |
N | 208000000X | Pediatrician | 4301091413 | MI |
N | 208000000X | Pediatrician | A74212 | CA |
N | 2080P0201X | Pediatric Allergist | A74212 | CA |
NPI | 1629044037 |
---|---|
Provider Name | Dr. Emily T Wang |
First Address | Canton, MI 48188-1992 |
Second Address | Canton, MI 48188-1992 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 20/07/2016 |