Provider Demographics
NPI:1982806279
Name:WANG, EDWARD HAOCHUAN (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:HAOCHUAN
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAOCHUAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3201 S WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3501
Mailing Address - Country:US
Mailing Address - Phone:312-326-3200
Mailing Address - Fax:312-326-3207
Practice Address - Street 1:3201 S WALLACE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3501
Practice Address - Country:US
Practice Address - Phone:312-326-3200
Practice Address - Fax:312-326-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120765Medicaid