Individual provider Active NPI

Lee Ming-Li Wang, MD

  • Psychiatry Physician
  • East Lansing, MI
National Provider Identifier
1306870985
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301074080 Issued in MI
Practice address
463 E Circle Dr
East Lansing, MI 48824-7500
Phone
(517) 884-6546
Fax
(517) 432-9460
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301074080 MI Primary

Addresses

Primary practice location

463 E Circle Dr
East Lansing, MI 48824-7500

Mailing address

804 Service Rd # A201
East Lansing, MI 48824-7015
Phone (517) 884-2976

Other identifiers 2

IdentifierTypeStateIssuer
4758295MedicaidMI
1306870985MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050906000168 MI Practitioner - Psychiatry 0749212389 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301074080MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan State University Psychiatry Current Accepting new patients
Board of Trustees of Michigan State University CurrentSince Oct 8, 2010 Accepting new patients
Michigan State University CurrentSince Oct 8, 2010 Accepting new patients

Locations

463 E Circle Dr
Rm 102
East Lansing, MI 48824
Phone (517) 884-6546

463 E Circle Dr
East Lansing, MI 48824
Phone (517) 355-8237

Interoperability endpoints

  • Direct secure messaging: lee.wang.1@25394.direct.athenahealth.com

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1306870985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD # A201",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-884-2976",
            "fax_number": "517-432-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "463 E CIRCLE DR",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247500",
            "telephone_number": "517-884-6546",
            "fax_number": "517-432-9460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "LEE",
        "middle_name": "MING-LI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301074080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4758295",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306870985",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.