Healthcare Provider Details

I. General information

NPI: 1861474116
Provider Name (Legal Business Name): ARTHUR F WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S. MAIN SUITE 101
MISHAWAKA IN
46544-2159
US

IV. Provider business mailing address

303 S. MAIN SUITE 101
MISHAWAKA IN
46544-2159
US

V. Phone/Fax

Practice location:
  • Phone: 574-257-1000
  • Fax: 574-257-0697
Mailing address:
  • Phone: 574-257-1000
  • Fax: 574-257-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1037862
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: