Healthcare Provider Details

I. General information

NPI: 1740570837
Provider Name (Legal Business Name): LAUREN FRANCIS WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN SIMENDINGER MD

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 BURNET AVE
CINCINNATI OH
45229-3091
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-8600
  • Fax: 513-584-8620
Mailing address:
  • Phone: 513-585-5501
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-121758
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: