Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 036146543 | IL |
NPI | 1013273150 |
---|---|
Provider Name | Miss Zuie Wakade |
First Address | Clinton Twp, MI 48038-3504 |
Second Address | Maywood, IL 60153-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 05/05/2021 |