Provider Demographics
NPI:1245213073
Name:HWANG, GENE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:L
Last Name:HWANG
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 1:225 S WHITTAKER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BUFFALO
Mailing Address - State:MI
Mailing Address - Zip Code:49117-1377
Mailing Address - Country:US
Mailing Address - Phone:269-469-0202
Mailing Address - Fax:
Practice Address - Street 1:225 S WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1377
Practice Address - Country:US
Practice Address - Phone:269-469-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000110069OtherFEDERAL BLUE CROSS
MI0110069OtherBLUE CROSS BLUE SHIELD MI
MI0110069OtherBLUE CROSS BLUE SHIELD MI