Provider Demographics
NPI:1912225970
Name:WANG, LU
Entity type:Individual
Prefix:DR
First Name:LU
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 N OAKLAWN AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2523
Mailing Address - Country:US
Mailing Address - Phone:630-333-9006
Mailing Address - Fax:
Practice Address - Street 1:201 E HURON ST. NORTHWESTERN MEMORIAL HOSPITAL
Practice Address - Street 2:7-132A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-503-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059720207ZP0102X, 390200000X
IN11015359A390200000X
OH57.016540390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program