Provider Demographics
NPI:1609918952
Name:WADE, ELIZABETH HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HOWARD
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1820
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-721-8670
Practice Address - Street 1:7926 PRESTON HWY STE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3848
Practice Address - Country:US
Practice Address - Phone:502-964-4357
Practice Address - Fax:502-966-5948
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1049804OtherPASSPORT
IN300011728Medicaid
KYK221580OtherMEDICARE
KY1072559OtherPASSPORT
KY64180623Medicaid
KY000000050234OtherANTHEM
KY1072555OtherPASSPORT
KY1050067OtherPASSPORT
KY1049813OtherPASSPORT