MEDICARE: DR. DIAN 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	2085R0001X	Radiation Oncology Physician	036-134510	IL

General Provider Information

NPI Number	:	1841246030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIAN WANG MD

Provider Business Mailing Address
First Line	:	500 S PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3804
Country	:	US
Telephone Number	:	312-942-5751
Fax Number	:	312-942-2339

Provider Business Practice Location Address
First Line	:	500 S PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3804
Country	:	US
Telephone Number	:	312-942-5751
Fax Number	:	312-942-2339

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/25/2015

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