Healthcare Provider Details

I. General information

NPI: 1093752990
Provider Name (Legal Business Name): ELAINE LEE WADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD KELLOGG CANCER CARE CENTER
GLENVIEW IL
60026-1301
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5826
  • Fax: 847-832-6183
Mailing address:
  • Phone: 847-570-1206
  • Fax: 847-570-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036084287
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036084287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: