MEDICARE: DR. CHEN CHII WANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036049733	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336153758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHEN CHII WANG MD

Provider Business Mailing Address
First Line	:	12240 S CHEYENNE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1654
Country	:	US
Telephone Number	:	773-873-3434
Fax Number	:	773-873-0208

Provider Business Practice Location Address
First Line	:	8201 S ASHLAND
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620
Country	:	US
Telephone Number	:	773-873-3434
Fax Number	:	773-873-0208

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/16/2010

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