Provider Demographics
NPI:1801356456
Name:WANG, REBECCA (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:31275 NORTHWESTERN HWY STE 140
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2531
Mailing Address - Country:US
Mailing Address - Phone:248-538-0109
Mailing Address - Fax:248-538-0675
Practice Address - Street 1:31275 NORTHWESTERN HWY STE 140
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2531
Practice Address - Country:US
Practice Address - Phone:248-538-0109
Practice Address - Fax:248-538-0675
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301508585207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology