MEDICARE: ELAINE LEE WADE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	036084287	IL
2	207RX0202X	Medical Oncology Physician	036084287	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093752990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE LEE WADE MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:	EVANSTON HOSPITAL
City	:	EVANSTON
State	:	IL
Zip	:	60201
Country	:	US
Telephone Number	:	847-570-1206
Fax Number	:	847-570-1248

Provider Business Practice Location Address
First Line	:	2100 PFINGSTEN RD
Second Line	:	KELLOGG CANCER CARE CENTER
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1301
Country	:	US
Telephone Number	:	847-657-5826
Fax Number	:	847-832-6183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/19/2024

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Directions to “ ELAINE LEE WADE MD” Practice Location

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