Individual
PAUL W WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6100 NEWPORT RD, SUITE 100, PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Mailing address
6100 NEWPORT RD, SUITE 100, PORTAGE, MI 49002-9235
(269) 343-4679
(269) 343-5929
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301026711
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1260265
—
MI
Enumeration date
10/03/2006
Last updated
07/08/2007
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