MEDICARE: MS. ARQUETTE C WADE MMS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	085003025	IL

General Provider Information

NPI Number	:	1710214069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARQUETTE C WADE MMS, PA-C

Provider Business Mailing Address
First Line	:	7047 S CALUMET AVE
Second Line	:	APT 1
City	:	CHICAGO
State	:	IL
Zip	:	60637-4629
Country	:	US
Telephone Number	:	773-454-3174
Fax Number	:

Provider Business Practice Location Address
First Line	:	7114 S VINCENNES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3506
Country	:	US
Telephone Number	:	773-224-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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