Healthcare Provider Details

I. General information

NPI: 1972565323
Provider Name (Legal Business Name): LI FEN WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE LF WANG MD

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 CONNECTICUT DR
MERRILLVILLE IN
46410-7170
US

IV. Provider business mailing address

9012 CONNECTICUT DR
MERRILLVILLE IN
46410-7170
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-6177
  • Fax: 219-769-1374
Mailing address:
  • Phone: 219-769-6177
  • Fax: 219-769-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01029282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: