MEDICARE: DR. EMILY T 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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	4301091413	MI
2	208000000X	Pediatrics Physician	A74212	CA
3	2080P0201X	Pediatric Allergy/Immunology Physician	A74212	CA
4	207K00000X	Allergy & Immunology Physician	4301091413	MI
5	208000000X	Pediatrics Physician	4301091413	MI

General Provider Information

NPI Number	:	1629044037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY T WANG MD

Provider Business Mailing Address
First Line	:	1600 S CANTON CENTER RD
Second Line	:	SUITE 360
City	:	CANTON
State	:	MI
Zip	:	48188-1992
Country	:	US
Telephone Number	:	734-394-2661
Fax Number	:	734-394-2666

Provider Business Practice Location Address
First Line	:	1600 S CANTON CENTER RD
Second Line	:	SUITE 360
City	:	CANTON
State	:	MI
Zip	:	48188-1992
Country	:	US
Telephone Number	:	734-394-2661
Fax Number	:	734-394-2666

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/20/2016

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Directions to “ DR. EMILY T WANG MD” Practice Location

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