Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301070289 | MI |
N | 111NI0900X | Internist | 4301070289 | MI |
Y | 207SG0201X | Clinical Genetics (M.D.) | 4301070289 | MI |
NPI | 1780791582 |
---|---|
Provider Name | Xia Wang |
First Address | Saginaw, MI 48602-5303 |
Second Address | Saginaw, MI 48601-2556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
444870110 | (05) | MI |
700H262220 | BLUE CROSS-BLUE CROSS (01) | |
H74745 | (02) | |
XW070289 | CHAMPUS-CHAMPUS (01) | |
XW070289 | COMMERCIAL-COMMERCIAL NUMBER (01) |