Provider Demographics
NPI:1861474116
Name:WANG, ARTHUR F (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:F
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 1:303 S. MAIN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2159
Mailing Address - Country:US
Mailing Address - Phone:574-257-1000
Mailing Address - Fax:574-257-0697
Practice Address - Street 1:303 S. MAIN
Practice Address - Street 2:SUITE 101
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2159
Practice Address - Country:US
Practice Address - Phone:574-257-1000
Practice Address - Fax:574-257-0697
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1037862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDC1877OtherRAILROAD MEDICARE
INP000153254OtherRAILROAD MEDICARE
IN10091980B22Medicaid
D94944Medicare UPIN
IN217290Medicare PIN