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General NPI Number Information
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NPI Number | 1841456613
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Entity Type | Organization
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Legal Business Name | BONITA M L WANG, D,O.,PLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1425 S GRAHAM RD
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City | FLINT
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State | MI
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Zip | 48532-3538
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Country | US
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Telephone | 810-732-1900
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Fax | 810-732-1925
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Provider Business Mailing Address
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Address Line | 12745 S SAGINAW ST STE 806-189
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City | GRAND BLANC
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State | MI
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Zip | 48439-2437
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Country | US
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Telephone | 810-732-1900
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Fax | 810-732-1925
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Authorized Official
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Title or Position | OWNER
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Name | BONITA M L WANG, D.O., PLC
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Credential | D.O.
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Telephone | 810-732-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101011000
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License Number State | MI
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