Individual
FANGDA JIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7500
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
84732
WI
207Q00000X
Family Medicine Physician
PT20162
ND
208M00000X
Hospitalist Physician
Primary
84732
WI
390200000X
Student in an Organized Health Care Education/Training Program
MT221145
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100297012
—
WI
Enumeration date
06/05/2020
Last updated
01/28/2025
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