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General NPI Number Information
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NPI Number | 1336257567
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Entity Type | Individual
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Provider Name | WENG PENG MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3641 RIDGE ROAD SUITE #5
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City | HIGHLAND
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State | IN
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Zip | 46322
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Country | US
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Telephone | 219-972-3811
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Fax | 219-972-3844
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Provider Business Mailing Address
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Address Line | 3641 RIDGE ROAD SUITE #5
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City | HIGHLAND
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State | IN
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Zip | 46322
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Country | US
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Telephone | 219-972-3811
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Fax | 219-972-3844
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01035904A
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License Number State | IN
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