Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301033147 | MI |
N | 208600000X | Surgeon | 4301033147 | MI |
Y | 2086S0105X | Surgery of the Hand | 4301033147 | MI |
NPI | 1649262734 |
---|---|
Provider Name | Leslie B Wong |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4096476 | (05) | MI |
A77385 | (02) |