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NPI Code Detail

MEDICARE: WADE BANKS JR.

MEDICARE:   WADE  BANKS JR.
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
1367500000XCertified Registered Nurse Anesthetist209033161IL
2163W00000XRegistered Nurse041464028IL

General Provider Information

NPI Number : 1376329078
Entity Type Code : Individual
Provider Name (Legal Business Name) : WADE BANKS JR.
Provider Business Mailing Address
First Line : 3333 GREEN BAY RD
Second Line :
City : NORTH CHICAGO
State : IL
Zip : 60064-3037
Country : US
Telephone Number : 773-619-2498
Fax Number :
Provider Business Practice Location Address
First Line : 3249 OAK PARK AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-3429
Country : US
Telephone Number : 708-783-9100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2023
Last Update Date : 03/26/2026

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