Healthcare Provider Details

I. General information

NPI: 1275627820
Provider Name (Legal Business Name): XIN WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE CENTER FOR PROSTATE CANCER 420 DELAWARE STREET SE, MAYO BUILDING, FOURTH FLOOR
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

UNIVERSITY OF MINNESOTA PHYSICIANS 420 DELAWARE ST SE MMC 292
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-6401
  • Fax:
Mailing address:
  • Phone: 612-625-6401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number39711
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: