Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 036093692 | IL |
NPI | 1245244730 |
---|---|
Provider Name | David Franklin Wax |
First Address | Chicago, IL 60614-3363 |
Second Address | Chicago, IL 60614-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 16/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036093692 | (05) | IL |
H73950 | (02) |