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General NPI Number Information
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NPI Number | 1750384186
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Entity Type | Individual
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Provider Name | GARY WAINER D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 6840 WINDSOR AVE
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City | BERWYN
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State | IL
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Zip | 60402-3441
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Country | US
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Telephone | 708-484-0042
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Fax | 708-749-5489
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Provider Business Mailing Address
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Address Line | 1415 W 22ND ST
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City | OAK BROOK
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State | IL
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Zip | 60523-2074
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Country | US
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Telephone | 630-933-5103
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036060677
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License Number State | IL
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