Healthcare Provider Details

I. General information

NPI: 1154548089
Provider Name (Legal Business Name): JACK S. WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD DEPARTMENT OF EMERGENCY MEDICINE
ARLINGTON HEIGHTS IL
60005-2349
US

IV. Provider business mailing address

800 W CENTRAL RD DEPARTMENT OF EMERGENCY MEDICINE
ARLINGTON HEIGHTS IL
60005-2349
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-3040
  • Fax: 847-618-3049
Mailing address:
  • Phone: 847-618-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-114930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: