Individual
WILEY FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
28080 GRAND RIVER AVE STE 306N, FARMINGTON HILLS, MI 48336-5966
(947) 521-8314
(248) 478-8864
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
5101007795
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126488
CARE CHOICES
MI
05
—
2869034
—
MI
01
—
4036071
AETNA
MI
01
—
5634383
BLUE CROSS
MI
01
—
P49606
BLUE CROSS
MI
Enumeration date
06/10/2006
Last updated
11/17/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us