Provider Demographics
NPI:1306847447
Name:WANG, MICHAEL Y (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:1009 CROSSPOINTE DR STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0948
Practice Address - Country:US
Practice Address - Phone:239-963-1060
Practice Address - Fax:239-963-1059
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138M3Medicaid
FL92219OtherBLUE SHIELD
NC138M3OtherBLUE CROSS BLUE SHIELD
NC138M3OtherBLUE CROSS BLUE SHIELD
NC89138M3Medicaid
FLAC120VMedicare PIN