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NPI Code Detail

MEDICARE: DR. PAUL DAVID WADLER PH.D.

MEDICARE: DR. PAUL DAVID WADLER PH.D.
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
1103TC0700XClinical Psychologist38072TX
2103TC0700XClinical Psychologist071-005909IL

General Provider Information

NPI Number : 1538172812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAUL DAVID WADLER PH.D.
Provider Business Mailing Address
First Line : 180 N MICHIGAN AVE
Second Line : SUITE 1820
City : CHICAGO
State : IL
Zip : 60601-7401
Country : US
Telephone Number : 773-936-3222
Fax Number :
Provider Business Practice Location Address
First Line : 4635 SOUTHWEST FWY STE 635
Second Line :
City : HOUSTON
State : TX
Zip : 77027-7112
Country : US
Telephone Number : 713-850-0049
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 12/26/2018

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