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General NPI Number Information
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NPI Number | 1578841615
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Entity Type | Individual
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Provider Name | FANG WU M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 1500 S CALIFORNIA AVE. INTERNAL MEDICINE
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City | CHICAGO
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State | IL
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Zip | 60608
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Country | US
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Telephone | 778-257-5077
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Fax |
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Provider Business Mailing Address
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Address Line | 6421 PERSHING RD UNIT 404
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City | STICKNEY
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State | IL
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Zip | 60402-4181
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Country | US
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Telephone | 708-788-6268
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.060681
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A129348
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 125.060681
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A129348
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License Number State | CA
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