Provider Demographics
NPI:1992701098
Name:WANG, ANDREW MANONGDO (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MANONGDO
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2848 NILES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3352
Mailing Address - Country:US
Mailing Address - Phone:269-428-3300
Mailing Address - Fax:269-428-5005
Practice Address - Street 1:2848 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3352
Practice Address - Country:US
Practice Address - Phone:269-428-3300
Practice Address - Fax:269-428-5005
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086112207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4741387Medicaid
MI4826671Medicaid
MI4741387Medicaid
MI0A16290010Medicare PIN
MI4826671Medicaid