Daniel Wong Lopez-Tan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35095 Issued in WI

Practice address

850 Elm Grove Rd
Elm Grove, WI 53122-2527

Phone

(262) 879-8014

NPI assigned

May 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Legacy Hospice Cares LLC

  • Community Based Hospice Care Agency
  • Elm Grove, WI
  • NPI 1184136939

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

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.

• Milwaukee Internal Medicine Associates Inc

  • Multi-Specialty Clinic/Center
  • Milwaukee, WI
  • NPI 1457531345

  Internal Medicine

  Medicare reassignment NPD
• Legacy Hospice Cares LLC

  • Community Based Hospice Care Agency
  • Elm Grove, WI
  • NPI 1184136939
  NPD (past)

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1932156205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15575 GRANDVIEW DRIVE LOWER",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052982",
            "telephone_number": "414-755-9104",
            "fax_number": "414-777-1812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 ELM GROVE RD",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222527",
            "telephone_number": "262-879-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ-TAN",
        "first_name": "DANIEL",
        "middle_name": "WONG",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "35095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lice Clinics of America Milwaukee
• Kaila Ann Ligocki
• Gloria T List, DDS
• Living Well Occupational Therapy, LLC
• Living Your Design, LLC
• Nicholas Walter Lueloff, MS, LPC
• Elisabeth Magnus, PT
• Camille Marasigan
• Maria Zanoni Physical Therapy Inc
• Mark Koch DC LLC

• Internal Medicine Physician in Elm Grove, WI
• Providers in Elm Grove, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.