MEDICARE: DR. JILL S 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	207R00000X	Internal Medicine Physician	4301085238	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00245264	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1101110672	OTHER	MI	BLUE CROSS PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508800020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL S WANG MD

Provider Business Mailing Address
First Line	:	5515 CLEVELAND AVE
Second Line	:
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

Provider Business Practice Location Address
First Line	:	5515 CLEVELAND AVE
Second Line	:
City	:	STEVENSVILLE
State	:	MI
Zip	:	49127-9670
Country	:	US
Telephone Number	:	269-429-9644
Fax Number	:	269-429-4002

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. JILL S WANG MD” Practice Location

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