Provider Demographics
NPI:1396701553
Name:WANG, ZILIN (MD)
Entity type:Individual
Prefix:DR
First Name:ZILIN
Middle Name:
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:PO BOX 1455
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1455
Mailing Address - Country:US
Mailing Address - Phone:601-900-8500
Mailing Address - Fax:920-268-1613
Practice Address - Street 1:100 WHISPER LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7881
Practice Address - Country:US
Practice Address - Phone:601-900-8500
Practice Address - Fax:920-268-1613
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19834207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03229528Medicaid
MS1952537219OtherMEDICARE RAILROAD
MS060010853Medicare PIN