Healthcare Provider Details

I. General information

NPI: 1598982571
Provider Name (Legal Business Name): EAR INSTITUTE OF CHICAGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SALT CREEK LN SUITE 101
HINSDALE IL
60521-2902
US

IV. Provider business mailing address

11 SALT CREEK LN SUITE 101
HINSDALE IL
60521-2902
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-3110
  • Fax: 630-789-3137
Mailing address:
  • Phone: 630-789-3110
  • Fax: 630-789-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number036047459
License Number StateIL

VIII. Authorized Official

Name: DR. RICHARD J WIET
Title or Position: PARTNER
Credential: MD
Phone: 630-789-3110