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Contact Information

NEIL W WANGSTROM, MD
304 DETROIT ST
LA PORTE, IN46350-2497
 Phone: 219-325-3770
 Fax: 219-325-8181
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Otolaryngic Allergy

207YX0602X 04 Physician/Otolaryngology
 

Otolaryngology/Facial Plastic Surgery

207YX0905X 04 Physician/Otolaryngology
 

Otology & Neurotology

207YX0901X 04 Physician/Otolaryngology
 

Pediatric Otolaryngology

207YP0228X 04 Physician/Otolaryngology
 

Plastic Surgery within the Head & Neck

207YX0007X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for NEIL W WANGSTROM · (Male)

NPI # 1730189820
Status Active
Credentials MD
Entity Individual
Enumeration date 07/29/2005
Last updated 09/16/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01038858
  • IN Medicaid 100165330
  • IN Other 000000697664 ANTHEM
  • IN Other M400041676 MEDICARE PTAN
Hospital affiliation(s)
  • INDIANA UNIVERSITY HEALTH LA PORTE HOSPITAL - (Acute Care)
    1007 LINCOLNWAY
    LA PORTE, IN 46350
  • INDIANA UNIVERSITY HEALTH STARKE HOSPITAL - (Acute Care)
    102 E CULVER RD
    KNOX, IN 46534
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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