MEDICARE: MR. DANIEL WONG LOPEZ-TAN 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	35095	WI

General Provider Information

NPI Number	:	1932156205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL WONG LOPEZ-TAN MD

Provider Business Mailing Address
First Line	:	15575 GRANDVIEW DRIVE LOWER
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-2982
Country	:	US
Telephone Number	:	414-755-9104
Fax Number	:	414-777-1812

Provider Business Practice Location Address
First Line	:	850 ELM GROVE RD
Second Line	:
City	:	ELM GROVE
State	:	WI
Zip	:	53122-2527
Country	:	US
Telephone Number	:	262-879-8014
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	11/14/2023

Similar Medicare Providers

1184136939 — LEGACY HOSPICE CARES LLC
Practice Location Address:

850 ELM GROVE RD STE 21
ELM GROVE, WI
53122-2527

Practice Phone: 262-716-6802
Practice Fax:

1861161861 — ANNA SYLVIA WEBER PSYD
Practice Location Address:

850 ELM GROVE RD STE 17
ELM GROVE, WI
53122-2527

Practice Phone: 414-909-0114
Practice Fax:

1770457822 — DR. NATASHA BASU PHD
Practice Location Address:

850 ELM GROVE RD STE 17
ELM GROVE, WI
53122-2527

Practice Phone: 414-909-0110
Practice Fax:

1073482758 — DR. SAMANTHA SCHWARTZ PSYD
Practice Location Address:

850 ELM GROVE RD STE 17
ELM GROVE, WI
53122-2527

Practice Phone: 414-909-0110
Practice Fax:

1225125388 — UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC.
Practice Location Address:

38 CORNELIA LN
LAKE GROVE, NY
11755-2527

Practice Phone: 631-232-0011
Practice Fax: 631-232-0595

1235271149 — UNITED CEREBRAL PALSY ASSOCIATION OF GREATER SUFFOLK, INC
Practice Location Address:

38 CORNELIA LN
LAKE GROVE, NY
11755-2527

Practice Phone: 631-232-0011
Practice Fax:

Directions to “ MR. DANIEL WONG LOPEZ-TAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.