Individual
JOHN WANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
908 N ELM ST, SUITE 310, HINSDALE, IL 60521-3625
(630) 325-3310
(630) 325-9163
Mailing address
908 N ELM ST, SUITE 310, HINSDALE, IL 60521-3625
(630) 325-3310
(630) 325-9163
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036042495
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002220321
BC/BS GROUP #
IL
01
—
020008007
RR MEDICARE PROVIDER #
IL
05
—
036024295
—
IL
01
—
CD5773
RR MEDICARE GROUP #
IL
Enumeration date
08/11/2005
Last updated
11/21/2011
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