Healthcare Provider Details

I. General information

NPI: 1902947955
Provider Name (Legal Business Name): REBECCA MARION WURTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 W LUNT AVE
CHICAGO IL
60645-4816
US

IV. Provider business mailing address

2112 W LUNT AVE
CHICAGO IL
60645-4816
US

V. Phone/Fax

Practice location:
  • Phone: 773-743-4213
  • Fax: 773-761-7546
Mailing address:
  • Phone: 773-743-4213
  • Fax: 773-761-7546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: