MEDICARE: VIRGINIA A 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	207Q00000X	Family Medicine Physician	036.061619	IL

General Provider Information

NPI Number	:	1720012024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA A WADE MD

Provider Business Mailing Address
First Line	:	600 E COUNTY ROAD 300 N
Second Line	:
City	:	ARCOLA
State	:	IL
Zip	:	61910
Country	:	US
Telephone Number	:	217-268-5008
Fax Number	:	217-268-5010

Provider Business Practice Location Address
First Line	:	600 E COUNTY ROAD 300 N
Second Line	:
City	:	ARCOLA
State	:	IL
Zip	:	61910
Country	:	US
Telephone Number	:	217-268-5008
Fax Number	:	217-268-5010

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/31/2024

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Directions to “ VIRGINIA A WADE MD” Practice Location

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