Provider Demographics
NPI:1104834043
Name:WU, MING SHYONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MING
Middle Name:SHYONG
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 1:5308 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-784-2822
Mailing Address - Fax:773-784-3931
Practice Address - Street 1:5308 N BROADWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-784-2822
Practice Address - Fax:773-784-3931
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047143Medicaid
ILK53522Medicare PIN
D12658Medicare UPIN