Healthcare Provider Details

I. General information

NPI: 1386887701
Provider Name (Legal Business Name): MIN WANG M.D. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 OPUS PL STE 110
DOWNERS GROVE IL
60515-1164
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-0002
  • Fax: 773-989-2781
Mailing address:
  • Phone: 239-343-3064
  • Fax: 239-343-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME150087
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036131692
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME150087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: