Provider Demographics
NPI:1477538874
Name:WU, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-334-5566
Mailing Address - Fax:815-759-4008
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-334-5566
Practice Address - Fax:815-759-4008
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010028232085R0202X
IL0361077382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1601306OtherUHC
MO462197OtherHEALTHLINK
431142188OSUOtherMERCY
300122906OtherTRAVELERS
MO000000014047OtherESSENCE
140376000OtherDEPT OF LABOR
MO283240OtherGHP
IL08221955OtherILLINOIS BLUE
MO08221955OtherBLUE SHIELD
MO144352OtherBCBS
MO2207727OtherCIGNA
MO34311V3431OtherHEALTHCARE USA
MO205715006Medicaid
MO000000014047OtherESSENCE
MO283240OtherGHP
MOP00338312Medicare PIN
IL08221955OtherILLINOIS BLUE
MO34311V3431OtherHEALTHCARE USA
MO1601306OtherUHC