MEDICARE: DR. FON YEI SUN WU M.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
1	207Q00000X	Family Medicine Physician	036049988	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010043156	OTHER	IL	RAIL ROAD PROVIDER NO.
2	016-06684	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1588737142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FON YEI SUN WU M.D.

Provider Business Mailing Address
First Line	:	275 TIMBER TRAIL DR
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1455
Country	:	US
Telephone Number	:	630-530-1024
Fax Number	:	630-530-9425

Provider Business Practice Location Address
First Line	:	2306 E 75TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-3306
Country	:	US
Telephone Number	:	773-731-0014
Fax Number	:	773-731-2034

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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