Basic Information
| Provider Information | |||||||||
| NPI: | 1225082688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADAS | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 S MEYERS RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601815243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308737305 | ||||||||
| FaxNumber: | 6304163189 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 E BRUSH HILL RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601265658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307824050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 036085624 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060046174 | 01 | RAILROAD MEDICARE | OTHER | 036085624 | 05 | IL | MEDICAID |