Dr. Neil William Wangstrom
Otolaryngologist (ENT Doctor) Pediatric Otolaryngology Plastic Surgeon (Head & Neck) Otolaryngology/Facial Plastic Surgery
304 Detroit St
La Porte
, Indiana 46350-2497
Dr. Neil William Wangstrom
Otolaryngologist (ENT Doctor) Pediatric Otolaryngology Plastic Surgeon (Head & Neck) Otolaryngology/Facial Plastic Surgery
304 Detroit St
La Porte
, Indiana 46350-2497
(219) 326-2584
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About
Features
Specialties
- Otolaryngologist (ENT Doctor)
- Pediatric Otolaryngology
- Plastic Surgeon (Head & Neck)
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Dr. Neil William Wangstrom
- Po Box 1690
- La Porte, IN
- Zip : 46352-1690
- Fax : (219) 326-2584
- Phone : (219) 326-2312
Second Address
- Dr. Neil William Wangstrom
- 304 Detroit St
- La Porte, IN
- Zip : 46350-2497
- Fax : (219) 325-8181
- Phone : (219) 325-3770
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 01038858 | IN |
| N | 207YP0228X | Pediatric Otolaryngology | 01038858 | IN |
| N | 207YX0007X | Plastic Surgeon (Head & Neck) | 01038858 | IN |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 01038858 | IN |
National Provider Identifier
| NPI | 1730189820 |
|---|---|
| Provider Name | Dr. Neil William Wangstrom |
| First Address | La Porte, IN 46352-1690 |
| Second Address | La Porte, IN 46350-2497 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/07/2005 |
| Last Update Date | 16/09/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000697664 | ANTHEM (01) | IN |
| 100165330 | (05) | IN |
| E72879 | (02) | IN |
| M400041676 | MEDICARE PTAN (01) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.