Individual
DR. JESSE G. WARDLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11 SALT CREEK LN STE 101, HINSDALE, IL 60521-3032
(630) 789-3110
Mailing address
11 SALT CREEK LN STE 101, HINSDALE, IL 60521-3032
(630) 789-3110
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036093003
IL
207YX0602X
Otolaryngic Allergy Physician
036093003
IL
207YX0901X
Otology & Neurotology Physician
036093003
IL
208D00000X
General Practice Physician
036093003
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093003
—
IL
Enumeration date
07/03/2006
Last updated
03/19/2021
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