Individual
MICHAEL FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8733 W 400 N, MICHIGAN CITY, IN 46360-9330
(219) 803-4145
(855) 502-1900
Mailing address
8733 W 400 N, MICHIGAN CITY, IN 46360-9330
(219) 803-4145
(855) 502-1900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01065093
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
IN PROCESS
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000580377
ANTHEM, BCBS
IN
05
—
200920160
—
IN
Enumeration date
10/09/2006
Last updated
01/10/2020
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