Provider Demographics
NPI:1831116433
Name:WADLEY, CALVIN P (MD, FACEP)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:P
Last Name:WADLEY
Suffix:
Gender:M
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N OAK PARK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1362
Mailing Address - Country:US
Mailing Address - Phone:708-524-8904
Mailing Address - Fax:708-524-8907
Practice Address - Street 1:109 N OAK PARK AVE APT 2
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1362
Practice Address - Country:US
Practice Address - Phone:708-524-8904
Practice Address - Fax:708-524-8907
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050417207P00000X
MN20748207P00000X
NC200600526207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050417Medicaid
NC144XNOtherBCBS OF NC
NC5906423Medicaid
NC144XNOtherBCBS OF NC
IL036050417Medicaid
NC5906423Medicaid
NC2064527Medicare PIN