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General NPI Number Information
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NPI Number | 1831116433
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Entity Type | Individual
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Provider Name | CALVIN P WADLEY M.D., FACEP
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 109 N OAK PARK AVE APT 2
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City | OAK PARK
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State | IL
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Zip | 60301-1362
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Country | US
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Telephone | 708-524-8904
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Fax | 708-524-8907
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Provider Business Mailing Address
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Address Line | 109 N OAK PARK AVE APT 2
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City | OAK PARK
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State | IL
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Zip | 60301-1362
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Country | US
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Telephone | 708-524-8904
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Fax | 708-524-8907
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-050417
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20748
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 200600526
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License Number State | NC
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