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NPI Code Detail

MEDICARE: DR. WESLEY BLAKE WONG M.D.

MEDICARE:  DR. WESLEY BLAKE WONG  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
12084N0400XNeurology Physician01031410AIN

General Provider Information

NPI Number : 1477610293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WESLEY BLAKE WONG M.D.
Provider Business Mailing Address
First Line : 4753 E 136TH ST
Second Line :
City : CARMEL
State : IN
Zip : 46033-9339
Country : US
Telephone Number : 317-843-9146
Fax Number :
Provider Business Practice Location Address
First Line : 220 VIRGINIA AVE
Second Line : MAIL NO. IN0205-A547
City : INDIANAPOLIS
State : IN
Zip : 46204-3709
Country : US
Telephone Number : 317-287-8524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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Directions to “ DR. WESLEY BLAKE WONG M.D.” Practice Location

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