Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 125.073689 | IL |
Y | 111NI0900X | Internist | 125.073689 | IL |
NPI | 1003207663 |
---|---|
Provider Name | Pamela Anne Wax |
First Address | Chicago, IL 60611-3055 |
Second Address | Chicago, IL 60611-3055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 19/06/2019 |