Healthcare Provider Details

I. General information

NPI: 1114938156
Provider Name (Legal Business Name): HONG CHU WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E DIVISION ST
FOND DU LAC WI
54935-3734
US

IV. Provider business mailing address

200 E WASHINGTON ST P O BOX 8031
APPLETON WI
54911-5490
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-4101
  • Fax: 920-926-4190
Mailing address:
  • Phone: 800-236-1428
  • Fax: 920-739-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number22834
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: