Provider Demographics
NPI:1386837474
Name:AMDE, WENDEWESSEN (MD)
Entity type:Individual
Prefix:
First Name:WENDEWESSEN
Middle Name:
Last Name:AMDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E WACKER DR
Mailing Address - Street 2:STE. #3150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1474
Mailing Address - Country:US
Mailing Address - Phone:312-527-1880
Mailing Address - Fax:
Practice Address - Street 1:1 E WACKER DR
Practice Address - Street 2:STE. #3150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1474
Practice Address - Country:US
Practice Address - Phone:312-527-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129646207W00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1386837474Medicaid