Healthcare Provider Details

I. General information

NPI: 1639391618
Provider Name (Legal Business Name): ASHLEY XIAOXUE WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

2737 LANGLEY CIR
GLENVIEW IL
60026-7736
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7046
  • Fax:
Mailing address:
  • Phone: 847-858-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: