Provider Demographics
NPI:1841456613
Name:BONITA M L WANG, D,O.,PLC
Entity type:Organization
Organization Name:BONITA M L WANG, D,O.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:M L
Authorized Official - Last Name:WANG, D.O., PLC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-732-1900
Mailing Address - Street 1:12745 S SAGINAW ST
Mailing Address - Street 2:STE 806-189
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-732-1900
Mailing Address - Fax:810-732-1925
Practice Address - Street 1:1425 S GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3538
Practice Address - Country:US
Practice Address - Phone:810-732-1900
Practice Address - Fax:810-732-1925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty