Provider Demographics
NPI:1790908168
Name:WANG, HUAN (MD)
Entity Type:Individual
Prefix:
First Name:HUAN
Middle Name:
Last Name:WANG
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 1:4012 SAWYER RD STE 101-104
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1231
Mailing Address - Country:US
Mailing Address - Phone:941-893-2688
Mailing Address - Fax:941-893-2690
Practice Address - Street 1:4012 SAWYER RD STE 101-104
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1231
Practice Address - Country:US
Practice Address - Phone:941-893-2688
Practice Address - Fax:941-893-2690
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120451207T00000X
IL336081804207T00000X
MA227516207T00000X
FLME120232207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270422Medicare PIN
R03044Medicare PIN
IL6447860011Medicare NSC
0533210001Medicare NSC