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NPI Code Detail

MEDICARE: JOELLE WAZEN MD

MEDICARE: JOELLE WAZEN 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
12085R0202XDiagnostic Radiology PhysicianD0093147MD

General Provider Information

NPI Number : 1669824967
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOELLE WAZEN MD
Provider Business Mailing Address
First Line : 180 HARVESTER DR STE 110
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-6686
Country : US
Telephone Number : 773-702-1150
Fax Number :
Provider Business Practice Location Address
First Line : 10980 GRANTCHESTER WAY FL 5
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-6097
Country : US
Telephone Number : 301-902-1073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2016
Last Update Date : 08/03/2024

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