Provider Demographics
NPI:1184638389
Name:HAN, WADE W (MD)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:W
Last Name:HAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771989
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-1989
Mailing Address - Country:US
Mailing Address - Phone:407-944-3340
Mailing Address - Fax:407-944-3343
Practice Address - Street 1:3270 GREENWALD WAY N
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0728
Practice Address - Country:US
Practice Address - Phone:407-944-3340
Practice Address - Fax:407-944-3343
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75769207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254295100Medicaid
FL43687Medicare PIN
FL254295100Medicaid