Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036105600 | IL |
N | 208200000X | Surgeon | 036105600 | IL |
N | 208600000X | Surgeon | 036105600 | IL |
N | 2086S0129X | Vascular Surgeon | 036105600 | IL |
Y | 208D00000X | General Practice Physician | 036105600 | IL |
NPI | 1033281506 |
---|---|
Provider Name | Dr. John C Wu |
First Address | Chicago, IL 60649 |
Second Address | Chicago, IL 60649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 19/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016-28281 | BLUE CROSS& BLUE SHIELD (01) | IL |
020052978 | RAIL ROAD PROVIDER NO. (01) | IL |
036105600 | (05) | IL |
14D0697995 | CLIA NO (01) | IL |
H53187 | (02) | IL |