Individual
CHRIS WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
370 E COURTLAND ST, MORTON, IL 61550-9054
(309) 291-0899
(309) 291-0927
Mailing address
370 E COURTLAND ST, MORTON, IL 61550-9054
(309) 291-0899
(309) 291-0927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001605
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00386420
RAILROAD MEDICARE
IL
Enumeration date
04/07/2006
Last updated
10/20/2021
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