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NPI Code Detail

MEDICARE: WIESMAN HAND SURGERY LLC

MEDICARE: WIESMAN HAND SURGERY LLC
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
12086S0122XPlastic and Reconstructive Surgery Physician

General Provider Information

NPI Number : 1538481593
Entity Type Code : Organization
Provider Name (Legal Business Name) : WIESMAN HAND SURGERY LLC
Provider Business Mailing Address
First Line : 712 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-3818
Country : US
Telephone Number : 773-275-5550
Fax Number : 312-981-1292
Provider Business Practice Location Address
First Line : 712 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-3818
Country : US
Telephone Number : 773-275-5550
Fax Number : 312-981-1292
Authorized Official
Title or Position : SOLE MEMBER
Name : IRVIN WIESMAN
Credential : MD
Telephone Number : 773-275-5550
Provider Enumeration Date : 02/18/2010
Last Update Date : 02/18/2010

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