Individual
MAXIMINO WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3703 W LAKE AVE, GLENVIEW, IL 60026-5823
(847) 904-5022
Mailing address
8059 E PRAIRIE RD, SKOKIE, IL 60076-3446
(773) 678-6718
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1600006607
IL
Other
Enumeration date
03/04/2014
Last updated
03/04/2014
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