Provider Demographics
NPI:1699703470
Name:WANG, DANNY D (MD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:D
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2727 E BELTLINE AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9611
Mailing Address - Country:US
Mailing Address - Phone:616-361-9205
Mailing Address - Fax:
Practice Address - Street 1:2727 E BELTLINE AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9611
Practice Address - Country:US
Practice Address - Phone:616-361-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDW069641207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104668240Medicaid
MI5524280001Medicare NSC
MIG53532Medicare UPIN
MI104668240Medicaid