Individual
MICHEAL D WANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2111 MIDLANDS CT, SYCAMORE, IL 60178-3125
(815) 758-0000
(815) 756-7130
Mailing address
2111 MIDLANDS CT, SYCAMORE, IL 60178-3125
(815) 758-0000
(815) 756-7130
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003083
IL
363A00000X
Physician Assistant
10000909A
IN
363AS0400X
Surgical Physician Assistant
085-003083
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000513306
ANTHEM
IN
01
—
035958001
DMERC
IL
Enumeration date
12/15/2006
Last updated
12/01/2020
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