Provider Demographics
NPI:1043479694
Name:WONG, RAY (MD)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10000 W INNOVATION DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4837
Mailing Address - Country:US
Mailing Address - Phone:414-456-5006
Mailing Address - Fax:414-456-6259
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:GENERAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5800
Practice Address - Fax:414-805-5809
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2011-06-10
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Provider Licenses
StateLicense IDTaxonomies
NY60-244952208600000X
WI55844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery