Healthcare Provider Details

I. General information

NPI: 1871533778
Provider Name (Legal Business Name): ALEXANDER MALCOLM WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/04/2025
Certification Date: 10/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5359 W FULLERTON
CHICAGO IL
60639
US

IV. Provider business mailing address

1740 W TAYLOR ST UNIVERSITY OF ILLINOIS HOSPITAL
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 773-836-2785
  • Fax: 773-836-7381
Mailing address:
  • Phone: 312-996-4185
  • Fax: 312-413-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036095568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: