Provider Demographics
NPI:1093752990
Name:WADE, ELAINE LEE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LEE
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2100 PFINGSTEN RD
Practice Address - Street 2:KELLOGG CANCER CARE CENTER
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1301
Practice Address - Country:US
Practice Address - Phone:847-657-5826
Practice Address - Fax:847-832-6183
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084287207RX0202X
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084287Medicaid
G16473Medicare UPIN
IN626820Medicare ID - Type UnspecifiedMCARE GROUP PROV #
IL437901Medicare ID - Type UnspecifiedMCARE GROUP PROV #
INCE1551Medicare ID - Type UnspecifiedR R MCARE GROUP PROV #
IN626820HMedicare PIN
ILCA8459Medicare ID - Type UnspecifiedR R MCARE GROUP PROV #