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General NPI Number Information
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NPI Number | 1578183422
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Entity Type | Individual
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Provider Name | ROXANA WISWELL MD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 251 E HURON ST STE 16-738
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City | CHICAGO
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State | IL
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Zip | 60611-3055
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Country | US
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Telephone | 312-926-5924
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Fax | 312-926-6134
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-6686
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Country | US
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Telephone | 773-702-1150
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125.075470
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.075470
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036168609
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License Number State | IL
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