Healthcare Provider Details

I. General information

NPI: 1245213073
Provider Name (Legal Business Name): GENE L HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S WHITTAKER ST
NEW BUFFALO MI
49117-1377
US

IV. Provider business mailing address

225 S WHITTAKER ST
NEW BUFFALO MI
49117-1377
US

V. Phone/Fax

Practice location:
  • Phone: 269-469-0202
  • Fax:
Mailing address:
  • Phone: 269-469-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301048288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: