Healthcare Provider Details

I. General information

NPI: 1306847447
Provider Name (Legal Business Name): MICHAEL Y WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 CROSSPOINTE DR STE 2
NAPLES FL
34110-0948
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-963-1060
  • Fax: 239-963-1059
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200401150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: