Healthcare Provider Details

I. General information

NPI: 1225262967
Provider Name (Legal Business Name): SHEILA XINGYUN WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2009
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE STE 100
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

245 CHERRY ST SE STE 100
GRAND RAPIDS MI
49503-4607
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-3200
  • Fax: 616-458-3526
Mailing address:
  • Phone:
  • Fax: 616-458-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301099985
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: