Provider Demographics
NPI:1629044037
Name:WANG, EMILY T (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:T
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:T
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHU
Mailing Address - Street 1:1600 S CANTON CENTER RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1992
Mailing Address - Country:US
Mailing Address - Phone:734-394-2661
Mailing Address - Fax:734-394-2666
Practice Address - Street 1:1600 S CANTON CENTER RD
Practice Address - Street 2:SUITE 360
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1992
Practice Address - Country:US
Practice Address - Phone:734-394-2661
Practice Address - Fax:734-394-2666
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091413207RA0201X, 207K00000X, 208000000X
CAA74212208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A742120Medicaid
CA00A742120Medicare UPIN
MIH99718Medicare UPIN
CAH99718Medicare UPIN