Healthcare Provider Details

I. General information

NPI: 1033281506
Provider Name (Legal Business Name): JOHN C WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 EAST 75TH STREET
CHICAGO IL
60649
US

IV. Provider business mailing address

2306 EAST 75TH STREET
CHICAGO IL
60649
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-0014
  • Fax: 773-731-2034
Mailing address:
  • Phone: 773-731-0014
  • Fax: 773-731-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036105600
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036105600
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036105600
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036105600
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: