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General NPI Number Information
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NPI Number | 1831388479
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Entity Type | Individual
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Provider Name | WILFRED V MESINA RT
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Gender | Male
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 6016 W BARRY AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5105
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Country | US
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Telephone | 773-818-6775
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Fax | 773-622-8608
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Provider Business Mailing Address
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Address Line | 6016 W BARRY AVE
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City | CHICAGO
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State | IL
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Zip | 60634-5105
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Country | US
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Telephone | 773-818-6775
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Fax | 773-622-8608
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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 | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State | IL
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