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General NPI Number Information
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NPI Number | 1225511611
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Entity Type | Individual
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Provider Name | ANDI WANG
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 06/02/2024
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Provider Practice Location Address
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Address Line | 260 E CHESTNUT ST APT 2005
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City | CHICAGO
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State | IL
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Zip | 60611-2457
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Country | US
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Telephone | 216-213-8743
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | TRN36059
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 125080158
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License Number State | IL
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