Healthcare Provider Details

I. General information

NPI: 1912958992
Provider Name (Legal Business Name): JOAN C WHELCHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S MICHIGAN AVE
CHICAGO IL
60603-5902
US

IV. Provider business mailing address

1536 N WIELAND ST
CHICAGO IL
60610-1233
US

V. Phone/Fax

Practice location:
  • Phone: 312-553-1818
  • Fax:
Mailing address:
  • Phone: 312-943-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: