Provider Demographics
NPI:1740272368
Name:WANG, JACK Z (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:Z
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:501-219-8900
Mailing Address - Fax:501-410-1148
Practice Address - Street 1:1700 CLINTON ST
Practice Address - Street 2:HACKLEY CANCER CENTER
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5502
Practice Address - Country:US
Practice Address - Phone:231-728-4949
Practice Address - Fax:231-728-4062
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2019-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI430100676422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI432196310Medicaid