Healthcare Provider Details

I. General information

NPI: 1023422797
Provider Name (Legal Business Name): ANDREW WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

IV. Provider business mailing address

4753 N BROADWAY ST STE 403
CHICAGO IL
60640-7910
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-2780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036144765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: