Healthcare Provider Details

I. General information

NPI: 1225956253
Provider Name (Legal Business Name): HECTOR DAVID WAUDBY-WEST MBCHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W HARRISON ST STE 570
CHICAGO IL
60612-3825
US

IV. Provider business mailing address

1750 W HARRISON ST STE 570
CHICAGO IL
60612-3825
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125089039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: