Individual
AUDREY L WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12 SALT CREEK LANE, STE 100, HINSDALE, IL 60521
(630) 654-4551
(630) 654-0498
Mailing address
12 SALT CREEK LANE, STE 100, HINSDALE, IL 60521
(630) 654-4551
(630) 654-0498
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
36060060
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220130801
BLUE CROSS BLUE SHIELD
IL
01
—
36060060
IL LICENSE
—
Enumeration date
09/11/2006
Last updated
07/08/2007
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