Provider Demographics
NPI:1760426308
Name:WU, SCOTT Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:Y
Last Name:WU
Suffix:
Gender:M
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 365
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-0365
Mailing Address - Country:US
Mailing Address - Phone:309-672-4980
Mailing Address - Fax:309-672-4980
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 500A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1005
Practice Address - Country:US
Practice Address - Phone:309-672-4980
Practice Address - Fax:309-671-2944
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086196207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL026249OtherHEALTH ALLIANCE
IL371221637OtherFEDERAL TAX IDENTIFICATIO
IL5134066OtherAETNA HEALTH PLANS
IL776530OtherMEDICARE GROUP NUMBER
IL036086196Medicaid
IL07215152OtherBLUE CROSS
ILIL0109OtherJOHN DEERE
IL295120OtherHEALTHLINK
ILF47484Medicare UPIN
IL036086196Medicaid