Healthcare Provider Details

I. General information

NPI: 1225151061
Provider Name (Legal Business Name): DEE DEE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 9TH ST N STE 300
NAPLES FL
34102-5820
US

IV. Provider business mailing address

2799 W GRAND BLVD # K-14
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4241
Mailing address:
  • Phone: 313-916-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301087906
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME170361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: