Individual
JEFFERY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
44201 DEQUINDRE, TROY, MI 48085
(248) 898-5000
Mailing address
26901 BEAUMONT BLVD # 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1952
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301061765
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300F362420
BCBSM
MI
05
—
4343826
—
MI
Enumeration date
03/24/2006
Last updated
10/09/2022
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