Wiesman, Gary G

Wiesman, Gary G is an sole proprietor health care provider with primary practice located at 712 N Dearborn St , Chicago IL 60654-3846. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery, which is considered as his primary health care specialty. Wiesman, Gary G can be contacted via phone (312) 796-5550.

Contact Information

Primary practice address
712 N Dearborn St Chicago IL 60654-3846
Phone: (312) 796-5550
Fax: (312) 981-1292
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery 207YX0905X 036042623 Illinois

Profile Details

NPI number 1821191404
LBN Legal business name Wiesman, Gary G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 7th, 2006
Last updated Apr 9th, 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 1821191404 NPPES
Illinois MEDICAID 036042623
Illinois Other 01621610

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