Provider Demographics
NPI:1962481598
Name:WU, PHILLIP C (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:C
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 1:500 DAVIS ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-424-1100
Mailing Address - Fax:847-864-6138
Practice Address - Street 1:500 DAVIS ST
Practice Address - Street 2:SUITE 810
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4668
Practice Address - Country:US
Practice Address - Phone:847-424-1100
Practice Address - Fax:847-864-6138
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031600193OtherBLUE SHIELD
ILP00147750OtherRAILROAD MEDICARE
IL1638347OtherBLUE SHIELD ID
IL0707260001OtherDMERC
IL0707260001OtherDMERC
ILH76334Medicare UPIN
IL0031600193OtherBLUE SHIELD
IL203957Medicare PIN