MEDICARE: TYIESHA WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1891455168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYIESHA WILSON

Provider Business Mailing Address
First Line	:	1440 W TAYLOR ST # 1105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 W LAKE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1908
Country	:	US
Telephone Number	:	773-999-6071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

Similar Medicare Providers

1326708694 — ACE CLINICAL EXPERTS LLC
Practice Location Address:

2800 W LAKE ST
CHICAGO, IL
60612-1908

Practice Phone: 773-999-6071
Practice Fax:

1306020656 — ANKITA SHAH DMD
Practice Location Address:

1202 W MADISON ST
CHICAGO, IL
60607-1908

Practice Phone: 312-724-7161
Practice Fax:

1205931581 — MS. ROBIN W BERGER LCSW
Practice Location Address:

30 N MICHIGAN AVE , SUITE 1908
CHICAGO, IL
60602

Practice Phone: 312-345-0202
Practice Fax: 773-975-4214

1396814380 — AIMEE C. BRUECK INC.
Practice Location Address:

1908 N MOHAWK ST , UNIT 22
CHICAGO, IL
60614-5220

Practice Phone: 773-677-3758
Practice Fax:

1689792301 — JILL WACHTER
Practice Location Address:

4021 N SOUTHPORT AVE # 2
CHICAGO, IL
60613-1908

Practice Phone: 847-507-6928
Practice Fax:

1609071992 — MS. AMY MARIE DAIGLER LCSW
Practice Location Address:

1908 W MONTROSE AVE
CHICAGO, IL
60613-1012

Practice Phone: 773-784-1262
Practice Fax:

Directions to “ TYIESHA WILSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.