Individual
JEFFREY C WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 448-7613
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01071171A
IN
207Q00000X
Family Medicine Physician
MT192454
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01071171A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000770499
ANTHEM FAMILY MEDICINE PIN
IN
01
—
000000824591
ANTHEM URGENT CARE PIN
IN
05
—
201069250
—
IN
Enumeration date
06/16/2008
Last updated
12/21/2022
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