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NPI Code Detail

MEDICARE: JAMIE BRENNA WABICH M.D.

MEDICARE: JAMIE BRENNA WABICH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician036138232IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036138232OTHERILILLINOIS PERMANENT LICENSE

General Provider Information

NPI Number : 1427324425
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE BRENNA WABICH M.D.
Provider Business Mailing Address
First Line : 800 N WESTMORELAND RD STE 100
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1671
Country : US
Telephone Number : 847-535-6083
Fax Number :
Provider Business Practice Location Address
First Line : 800 N WESTMORELAND RD STE 100
Second Line :
City : LAKE FOREST
State : IL
Zip : 60045-1671
Country : US
Telephone Number : 847-535-6083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2012
Last Update Date : 04/19/2018

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Directions to “ JAMIE BRENNA WABICH M.D.” Practice Location

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