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General NPI Number Information
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NPI Number | 1366444150
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Entity Type | Individual
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Provider Name | JOHN WANDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 908 N ELM ST SUITE 310
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City | HINSDALE
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State | IL
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Zip | 60521-3625
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Country | US
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Telephone | 630-325-3310
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Fax | 630-325-9163
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Provider Business Mailing Address
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Address Line | 908 N ELM ST SUITE 310
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City | HINSDALE
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State | IL
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Zip | 60521-3625
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Country | US
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Telephone | 630-325-3310
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Fax | 630-325-9163
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036042495
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License Number State | IL
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