Wichterman, Lisa
Wichterman, Lisa is an individual health care provider with primary practice located at 3050 Montvale Dr Ste A , Springfield IL 62704-6924. She recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as her primary health care specialty. Wichterman, Lisa can be contacted via phone (217) 726-8096.Contact Information
Primary practice address
3050 Montvale Dr Ste A
Springfield IL 62704-6924
Phone: (217) 726-8096
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 036065197 | Illinois |
Profile Details
| NPI number | 1881631075 |
|---|---|
| LBN Legal business name | Wichterman, Lisa |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2006 |
| Last updated | Aug 4th, 2015 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881631075 | NPPES |
| Illinois | MEDICAID | 036065197 |
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