Provider Demographics
NPI:1033281506
Name:WU, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 EAST 75TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-731-0014
Mailing Address - Fax:773-731-2034
Practice Address - Street 1:2306 EAST 75TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-731-0014
Practice Address - Fax:773-731-2034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105600207Q00000X, 208600000X, 2086S0129X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020052978OtherRAIL ROAD PROVIDER NO.
IL016-28281OtherBLUE CROSS& BLUE SHIELD
IL036105600Medicaid
IL14D0697995OtherCLIA NO
IL020052978OtherRAIL ROAD PROVIDER NO.
ILH53187Medicare UPIN