Provider Demographics
NPI:1528074705
Name:TSAI, WAN CHONG (MD)
Entity type:Individual
Prefix:
First Name:WAN
Middle Name:CHONG
Last Name:TSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WAN
Other - Middle Name:CHUEN
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 405
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-884-8600
Practice Address - Fax:517-884-8650
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062502208000000X, 2080P0214X
OH350968522080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH07089OtherPARAMOUNT
OH5243688OtherAETNA
MI3515022Medicaid
OH2083392Medicaid
MI1528074705Medicaid
MI0C36092297Medicare PIN
OH2083392Medicaid
MI1528074705Medicaid