Provider Demographics
NPI:1245244730
Name:WAX, DAVID FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANKLIN
Last Name:WAX
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:BOX 21 CHILDRENS MEMORIAL HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4553
Mailing Address - Fax:773-880-8111
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL CARDIOLOGY DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4553
Practice Address - Fax:773-880-8111
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360936922080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093692Medicaid
IL036093692Medicaid
ILL94720Medicare ID - Type Unspecified