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General NPI Number Information
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NPI Number | 1689094179
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Entity Type | Individual
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Provider Name | GRACE YIWEN WANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 7301 SECOR RD
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City | LAMBERTVILLE
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State | MI
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Zip | 48144-9737
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Country | US
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Telephone | 419-479-5795
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Fax | 419-479-5797
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Provider Business Mailing Address
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Address Line | 4235 SECOR RD
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City | TOLEDO
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State | OH
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Zip | 43623-4299
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Country | US
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Telephone | 419-473-3561
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Fax | 419-479-5593
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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 | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 4301104706
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101266067
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License Number State | VA
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