Provider Demographics
NPI:1639146111
Name:WU, SUSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:304 W HAY ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-877-2088
Mailing Address - Fax:217-877-3622
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 218
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-877-2088
Practice Address - Fax:217-877-3622
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036109858208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109858Medicaid
IL214418Medicare PIN
ILK33117Medicare UPIN