Mecklenburg, Brian Wade

Mecklenburg, Brian Wade is an individual health care provider with primary practice located at 2202 Harlem Road Suite 200, Loves Park IL 61111-2754. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Mecklenburg, Brian Wade can be contacted via phone (815) 877-4848.

Contact Information

Primary practice address
2202 Harlem Road Suite 200 Loves Park IL 61111-2754
Phone: (815) 877-4848
Fax: (815) 654-3271
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207LC0200X 0101102755 Virginia
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 036.149788 Illinois

Profile Details

NPI number 1912047085
LBN Legal business name Mecklenburg, Brian Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 7th, 2007
Last updated Jan 13th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912047085 NPPES
Illinois MEDICAID 036149788

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