Provider Demographics
NPI:1043324247
Name:WANG, GRACE HSUANHWA (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HSUANHWA
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W. MAIN STREET, P.O. BOX 359
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0359
Mailing Address - Country:US
Mailing Address - Phone:563-927-7698
Mailing Address - Fax:563-927-7469
Practice Address - Street 1:709 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-0359
Practice Address - Country:US
Practice Address - Phone:563-927-7698
Practice Address - Fax:563-927-7469
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102794207V00000X
IAMD-45432207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102794Medicaid
IL036102794Medicaid