Healthcare Provider Details

I. General information

NPI: 1447252804
Provider Name (Legal Business Name): CYNTHIA A WAIT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TOWER CT SUITE C
GURNEE IL
60031-5711
US

IV. Provider business mailing address

20 TOWER CT SUITE C
GURNEE IL
60031-5711
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-2960
  • Fax: 847-244-2986
Mailing address:
  • Phone: 847-244-2960
  • Fax: 847-244-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036-064315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: