Healthcare Provider Details

I. General information

NPI: 1275788705
Provider Name (Legal Business Name): ZHIQIANG BRAD WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2689
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2738
  • Fax:
Mailing address:
  • Phone: 313-916-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberME107392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10023529
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301112003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: