Provider Demographics
NPI:1699340687
Name:WU, KEVIN JULIUS (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JULIUS
Last Name:WU
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ERIE CT STE 6160
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2510
Mailing Address - Country:US
Mailing Address - Phone:331-330-5023
Mailing Address - Fax:
Practice Address - Street 1:1 ERIE CT STE 6160
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2510
Practice Address - Country:US
Practice Address - Phone:331-330-5023
Practice Address - Fax:740-756-6022
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-080991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty