Provider Demographics
NPI:1245630961
Name:WANG, AMY Y (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:Y
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N LAKE SHORE DR
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3152
Mailing Address - Country:US
Mailing Address - Phone:312-503-3229
Mailing Address - Fax:
Practice Address - Street 1:750 N LAKE SHORE DR
Practice Address - Street 2:11TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3152
Practice Address - Country:US
Practice Address - Phone:312-503-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360990272083C0008X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics