Provider Demographics
NPI:1972565323
Name:WANG, LI FEN (MD)
Entity Type:Individual
Prefix:
First Name:LI FEN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:LF
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9012 CONNECTICUT DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7170
Mailing Address - Country:US
Mailing Address - Phone:219-769-6177
Mailing Address - Fax:219-769-1374
Practice Address - Street 1:9012 CONNECTICUT DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7170
Practice Address - Country:US
Practice Address - Phone:219-769-6177
Practice Address - Fax:219-769-1374
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029282A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN91107987OtherBCBS OF IL
IN000000095392OtherANTHEM/BLUE CROSS BLUE SH
IN91107987OtherBCBS OF IL
INC25028Medicare UPIN
M400057155Medicare PIN