=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740825959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEN A. WANG, DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2019
-----------------------------------------------------
Last Update Date | 03/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3592 CENTER AVE
-----------------------------------------------------
City | ESSEXVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48732-1774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-276-1021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3592 CENTER AVE STE A
-----------------------------------------------------
City | ESSEXVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48732-1779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-276-1021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALLEN ANLIN WANG
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 734-276-1021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------