MEDICARE: DR. WEN-CHOU TANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	04-37304	KS
2	207Q00000X	Family Medicine Physician	01082905A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04-37304	OTHER	KS	MEDICAL LICENSE

General Provider Information

NPI Number	:	1033405626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WEN-CHOU TANG M.D.

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-479-3516
Fax Number	:	260-479-3520

Provider Business Practice Location Address
First Line	:	5717 S ANTHONY BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3386
Country	:	US
Telephone Number	:	260-458-3270
Fax Number	:	260-479-4604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	10/14/2020

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Directions to “ DR. WEN-CHOU TANG M.D.” Practice Location

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