| Simon Wu Md Ltd | |
|
400 N Wall St Ste 303 Kankakee IL 60901-2964 | |
| (815) 933-1664 | |
| (815) 935-5660 |
| Full Name | Simon Wu Md Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 400 N Wall St Ste 303, Kankakee, Illinois |
| Authorized Official Name and Position | Jennifer L Klinckman (OFFICE MANAGER) |
| Authorized Official Contact | 8159331664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Simon Wu Md Ltd 400 N Wall St Ste 303 Kankakee IL 60901-2964 Ph: (815) 933-1664 | Simon Wu Md Ltd 400 N Wall St Ste 303 Kankakee IL 60901-2964 Ph: (815) 933-1664 |
| NPI Number | 1831187715 |
|---|---|
| Provider Enumeration Date | 10/13/2005 |
| Last Update Date | 07/23/2024 |
| Medicare PECOS PAC ID | 9133270069 |
|---|---|
| Medicare Enrollment ID | O20090706000322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831187715 | NPI | - | NPPES |
| 036089802 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Simon K Wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407044241 PECOS PAC ID: 0446301378 Enrollment ID: I20090706000278 |
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