MEDICARE: DR. JOSHUA BRIAN WECHSLER M.D.

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	2080P0206X	Pediatric Gastroenterology Physician	036123428	IL

General Provider Information

NPI Number	:	1912109596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA BRIAN WECHSLER M.D.

Provider Business Mailing Address
First Line	:	2300 N CHILDRENS PLZ # 65
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3363
Country	:	US
Telephone Number	:	773-880-4354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2730
Country	:	US
Telephone Number	:	773-880-4355
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	02/23/2012

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