Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301090673 | MI |
NPI | 1013114602 |
---|---|
Provider Name | Dr. Frank Wang |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5135032441 | CONTR SUBST (01) | MI |