Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35.139772 | OH |
N | 208800000X | Urologist | 4301502613 | MI |
NPI | 1003208026 |
---|---|
Provider Name | Philip Wong |
First Address | Toledo, OH 43604-1558 |
Second Address | Toledo, OH 43606-3834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2015 |
Last Update Date | 15/07/2020 |