NPIMap

Individual provider Active NPI

Michael Leechun Wang, M.D., PH.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Medford, OR
National Provider Identifier
1265871032
Registry record updated Jul 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
69427 Issued in WI
Practice address
1032 E Jackson Street
Medford, OR 97504
Phone
(541) 770-4559
Fax
(541) 770-4511
NPI assigned
Jun 14, 2013
Last updated
Jul 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 69427 WI Primary

Addresses

Primary practice location

1032 E Jackson Street
Medford, OR 97504

Mailing address

PO Box 1000
Medford, OR 97501
Phone (541) 770-4559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, OR, CA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180918001256 WI Practitioner - Pathology 1557661089 Reassigns benefits to 1 organization
I20210421000250 OR Practitioner - Pathology 1557661089 Reassigns benefits to 1 organization
I20250327003150 CA Practitioner - Pathology 1557661089 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vista Pathology Laboratory LLCGroup PAC ID 4587827985, 12 clinicians

Practice addresses (Care Compare)

1032 E Jackson St
Medford, OR 97504-7027
Phone (541) 770-4559

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
69427WIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Columbia St. Mary's Hospital Milwaukee, Inc Current Accepting new patients
Siskiyou Hospital, Inc. CurrentSince Mar 7, 2025 Accepting new patients
Columbia St. Mary's Hospital Milwaukee Inc CurrentSince Aug 1, 2018 Accepting new patients
Vista Pathology Laboratory, LLC Anatomic Pathology & Clinical Pathology CurrentSince Apr 26, 2021 Accepting new patients
Vista Pathology Laboratory, LLC Anatomic Pathology & Clinical Pathology CurrentSince Apr 26, 2021 Accepting new patients
Columbia St. Mary's Hospital Milwaukee, Inc CurrentSince Aug 1, 2018 Accepting new patients
Sacred Heart Rehabilitation Institute, Inc Past Accepting new patients

Locations

444 Bruce St
Yreka, CA 96097
Phone (530) 841-6256

94220 4th St
Gold Beach, OR 97444
Phone (541) 247-3000

1032 E Jackson St
Medford, OR 97504
Phone (541) 770-4559

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

2061 Cheyenne Ct
Grafton, WI 53024
Phone (262) 243-4924

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

801 S 70th St
West Allis, WI 53214
Phone (414) 773-6600

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1265871032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97501",
            "telephone_number": "541-770-4559",
            "fax_number": "541-770-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 E JACKSON STREET",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-770-4559",
            "fax_number": "541-770-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "MICHAEL",
        "middle_name": "LEECHUN",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-14",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WI",
            "license": "69427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.