Healthcare Provider Details

I. General information

NPI: 1811723281
Provider Name (Legal Business Name): ZACHARY WIENER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1450
CHICAGO IL
60604-3535
US

IV. Provider business mailing address

53 W JACKSON BLVD STE 1450
CHICAGO IL
60604-3535
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-6192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: