Provider Demographics
NPI:1194901132
Name:WANG, STACI JOANN (MD)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:JOANN
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACI
Other - Middle Name:JOANN
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4201 ST. ANTOINE UHC 5D MAILBOX# 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN 2ND FLOOR CARL'S
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5515
Practice Address - Fax:313-745-5237
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics