Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | IL |
NPI | 1003877762 |
---|---|
Provider Name | Stephanie C.s. Wu |
First Address | North Chicago, IL 60064-3037 |
Second Address | North Chicago, IL 60064-3037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07809 | (02) | IL |