SearchIllinois101YM0800X

Wade Stark

NPI 1801430988 · on the registry since 2019

Practice

Address
626 W Lincoln Ave
Charleston, IL 61920
Phone
(217) 345-7702
Fax
(217) 345-7705
Organisation at this address
Southern Illinois Healthcare Foundation, Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
101YM0800X
101YM0800X
Also registered as
101YP2500X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2025-06-12

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois