Healthcare Provider Details

I. General information

NPI: 1700844818
Provider Name (Legal Business Name): XIAOYAN WANG M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BARNHILL DR A128
INDIANAPOLIS IN
46202-5126
US

IV. Provider business mailing address

635 BARNHILL DR A128
INDIANAPOLIS IN
46202-5126
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-4806
  • Fax:
Mailing address:
  • Phone: 317-274-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number01057427A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: