Provider Demographics
NPI:1831294016
Name:WU, JAN Q (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:Q
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1600 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2394
Practice Address - Country:US
Practice Address - Phone:517-381-6880
Practice Address - Fax:517-381-6881
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803302102OtherBCBS INDIVIDUAL PIN
MI3229836Medicaid
MI200000001062OtherPHP PIN #
MI0803302102OtherBCBS INDIVIDUAL PIN
MIF66031Medicare UPIN