Healthcare Provider Details

I. General information

NPI: 1639146111
Provider Name (Legal Business Name): SUSAN S WU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W HAY ST SUITE 218
DECATUR IL
62526-6328
US

IV. Provider business mailing address

304 W HAY ST SUITE 218
DECATUR IL
62526-6328
US

V. Phone/Fax

Practice location:
  • Phone: 217-877-2088
  • Fax: 217-877-3622
Mailing address:
  • Phone: 217-877-2088
  • Fax: 217-877-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036109858
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: