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Individual

SURESH H WADHWANI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D. S.C.

Contact information

Practice address
100 PROVENA WAY, BOURBONNAIS, IL 60914-4796
(815) 936-3200
Mailing address
455 W COURT ST, SUITE 302, KANKAKEE, IL 60901-3679
(815) 936-3250
(815) 936-3253

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036073974
IL
207RI0011X
Interventional Cardiology Physician
036073974
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036073974
IL
Enumeration date
02/22/2007
Last updated
10/16/2020
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