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General NPI Number Information
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NPI Number | 1235214982
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Entity Type | Individual
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Provider Name | WILBERTO NIEVES NEIRA MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 250 E SUPERIOR ST SUITE 05-2168 GYNECOLOGIC ONCOLOGY
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City | CHICAGO
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State | IL
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Zip | 60611-2914
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Country | US
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Telephone | 312-695-0990
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Fax | 312-472-4706
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR SUITE #1000
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-695-0665
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Fax | 312-695-0050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 25MA07442500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 036139777
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036-139777
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License Number State | IL
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