Provider Demographics
NPI:1760500813
Name:HWANG, SAM TZEN-YUE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:TZEN-YUE
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-3100
Mailing Address - Fax:414-955-6221
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-3100
Practice Address - Fax:414-955-6221
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424949207N00000X
WI52541207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760500813Medicaid
WI1760500813Medicaid
WI68086 1281Medicare PIN