Provider Demographics
NPI:1649211269
Name:WANG, STEPHEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9065 CIRCLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9310
Mailing Address - Country:US
Mailing Address - Phone:810-232-8888
Mailing Address - Fax:810-232-9190
Practice Address - Street 1:1121 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4733
Practice Address - Country:US
Practice Address - Phone:810-232-8888
Practice Address - Fax:810-232-9091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047299208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC1985OtherMCARE
MI34B560470OtherBLUECROSS / BCN
MI204016OtherMCLAREN HEALTHPLAN
MI086812OtherSELECTCARE
MIB46586OtherHAP
MI086812OtherSELECTCARE
MI204016OtherMCLAREN HEALTHPLAN