Provider Demographics
NPI:1841246030
Name:WANG, DIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIAN
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 1:500 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3804
Mailing Address - Country:US
Mailing Address - Phone:312-942-5751
Mailing Address - Fax:312-942-2339
Practice Address - Street 1:500 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3804
Practice Address - Country:US
Practice Address - Phone:312-942-5751
Practice Address - Fax:312-942-2339
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1345102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H67832Medicare UPIN
WI68086 0679Medicare PIN
004000261MOtherHUMANA
WI1841246030Medicaid
WI013773601Medicare PIN
WI32064 0140Medicare PIN