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NPI Code Detail

MEDICARE: DR. BENJAMIN JENG-SHING WANG MD PHD

MEDICARE: DR. BENJAMIN JENG-SHING WANG MD PHD
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
1207R00000XInternal Medicine Physician036061248IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14029169OTHERAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30031600025OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1962496182
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN JENG-SHING WANG MD PHD
Provider Business Mailing Address
First Line : 80 RIVER OAKS
Second Line : STE 813
City : CALUMET CITY
State : IL
Zip : 60409
Country : US
Telephone Number : 708-862-5783
Fax Number : 708-862-5784
Provider Business Practice Location Address
First Line : 80 RIVER OAKS
Second Line : STE 813
City : CALUMET CITY
State : IL
Zip : 60409
Country : US
Telephone Number : 708-862-5783
Fax Number : 708-862-5784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2005
Last Update Date : 01/26/2010

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