Healthcare Provider Details

I. General information

NPI: 1952537219
Provider Name (Legal Business Name): W M D HEART CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHISPER LAKE BLVD
MADISON MS
39110-7881
US

IV. Provider business mailing address

PO BOX 1455
MADISON MS
39130-1455
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-2424
  • Fax: 601-664-6675
Mailing address:
  • Phone: 601-664-2424
  • Fax: 601-664-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19834
License Number StateMS

VIII. Authorized Official

Name: ZILIN WANG
Title or Position: PHYSICIAN CEO
Credential: M.D.
Phone: 601-900-8500