Provider Demographics
NPI:1629417043
Name:WU, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:WU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:525 W RIVER WOODS PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1010
Mailing Address - Country:US
Mailing Address - Phone:414-453-7418
Mailing Address - Fax:414-967-1151
Practice Address - Street 1:525 W RIVER WOODS PKWY STE 230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1010
Practice Address - Country:US
Practice Address - Phone:414-453-7418
Practice Address - Fax:414-967-1151
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60932491207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629417043Medicaid
WI72418OtherSTATE OF WISCONSIN MEDICAL LICENSE