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General NPI Number Information
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NPI Number | 1982647434
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Entity Type | Individual
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Provider Name | EMMA C WANG DO
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Gender | Female
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 3006 LINCOLNWAY E
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City | MISHAWAKA
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State | IN
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Zip | 46544-3501
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Country | US
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Telephone | 574-252-7133
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Fax | 844-361-2090
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Provider Business Mailing Address
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Address Line | 3006 LINCOLNWAY E
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City | MISHAWAKA
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State | IN
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Zip | 46544-3501
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Country | US
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Telephone | 574-252-7133
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Fax | 844-361-2090
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02001493
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 002001493
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License Number State | IN
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