| Kan Y Wu, MD | |
|
907 West Lincoln Ave, Charleston, IL 61920-2413 | |
| (217) 345-2500 | |
| (217) 345-8366 |
| Full Name | Kan Y Wu |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 907 West Lincoln Ave, Charleston, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972590362 | NPI | - | NPPES |
| 036113712 | Medicaid | IL | |
| 01098 | Other | NE | BCBS OF NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 036113712 (Illinois) | Primary |
| 174400000X | Specialist | 18855 (Nebraska) | Secondary |
| Entity Name | East Central Illinois Radiology Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912277443 PECOS PAC ID: 3870750482 Enrollment ID: O20120209000712 |
| Mailing Address | Practice Location Address |
|---|---|
| Kan Y Wu, MD Po Box 770, 907 West Lincoln Ave, Charleston, IL 61920-2413 Ph: (217) 345-2500 | Kan Y Wu, MD 907 West Lincoln Ave, Charleston, IL 61920-2413 Ph: (217) 345-2500 |
Dr. Aldo Carmen Ruffolo, DO Radiology Medicare: Accepting Medicare Assignments Practice Location: 907 W Lincoln Ave, Charleston, IL 61920 Phone: 217-345-2100 Fax: 217-345-8366 | |
Jayasiri Ravinath Fernando, Radiology Medicare: Not Enrolled in Medicare Practice Location: 907 W Lincoln Ave, Charleston, IL 61920 Phone: 217-345-2100 Fax: 217-345-8366 |