Provider Demographics
NPI:1669777074
Name:WAN, ALAN WING-LUN (DO)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WING-LUN
Last Name:WAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 W MEDICAL CENTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8425
Mailing Address - Country:US
Mailing Address - Phone:815-759-8100
Mailing Address - Fax:815-759-8106
Practice Address - Street 1:4305 W MEDICAL CENTER DR STE 1
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-759-8100
Practice Address - Fax:815-759-8106
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133552207RX0202X, 207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400325774OtherMEDICARE PTAN INDIVIDUAL
IL036133552Medicaid
IL206147OtherMEDICARE PTAN GROUP