Basic Information
| Provider Information | |||||||||
| NPI: | 1558685115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAY-HOO DET, M.D., S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2007 MIDWEST CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605232526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303253701 | ||||||||
| FaxNumber: | 6303253701 | ||||||||
| Practice Location | |||||||||
| Address1: | 845 N MICHIGAN AVE | ||||||||
| Address2: | SUITE 948 E | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122020700 | ||||||||
| FaxNumber: | 3122020326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | DET | ||||||||
| AuthorizedOfficialFirstName: | WAY-HOO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6308863553 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036054528 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.