Individual
DR. JOHN C WU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2306 EAST 75TH STREET, CHICAGO, IL 60649
(773) 731-0014
(773) 731-2034
Mailing address
2306 EAST 75TH STREET, CHICAGO, IL 60649
(773) 731-0014
(773) 731-2034
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036105600
IL
208600000X
Surgery Physician
036105600
IL
2086S0129X
Vascular Surgery Physician
036105600
IL
208D00000X
General Practice Physician
Primary
036105600
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-28281
BLUE CROSS& BLUE SHIELD
IL
01
—
020052978
RAIL ROAD PROVIDER NO.
IL
05
—
036105600
—
IL
01
—
14D0697995
CLIA NO
IL
Enumeration date
11/13/2006
Last updated
09/28/2024
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