Organization
MENS HEALTH CHICAGO LLC
Active
Organization
MENS HEALTH CHICAGO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JR WADE (MEMBER)
(480) 229-1986
Entity
Organization
Contact information
Practice address
1396 NEWCASTLE CT, BARTLETT, IL 60103-2989
(480) 229-2013
Mailing address
12878 N 119TH ST, SCOTTSDALE, AZ 85259-2736
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP3397
AZ
Other
Enumeration date
06/10/2011
Last updated
06/10/2011
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