Individual
JOHN WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
520 NORTH FOURTH STREET, SPRINGFIELD, IL 62794
(217) 545-8000
Mailing address
520 NORTH FOURTH STREET, SPRINGFIELD, IL 62794
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
LP01289
RI
207Q00000X
Family Medicine Physician
Primary
125060808
IL
207Q00000X
Family Medicine Physician
37762
SC
207Q00000X
Family Medicine Physician
37762
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377648
—
SC
Enumeration date
09/26/2008
Last updated
11/16/2021
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