Healthcare Provider Details

I. General information

NPI: 1639469828
Provider Name (Legal Business Name): PETER WEI-JU WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2011
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W TAYLOR ST
CHICAGO IL
60612-7242
US

IV. Provider business mailing address

1855 W TAYLOR ST
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-8937
  • Fax:
Mailing address:
  • Phone: 312-996-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.138573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: