| Elisabeth I. Wallner, M.d., S.c. | |
|
676 N St Clair Suite 2250 Chicago IL 60611 | |
| (312) 926-0888 | |
| (312) 926-0889 |
| Full Name | Elisabeth I. Wallner, M.d., S.c. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 676 N St Clair, Chicago, Illinois |
| Authorized Official Name and Position | Elisabeth I Wallner (PRESIDENT) |
| Authorized Official Contact | 3129260888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elisabeth I. Wallner, M.d., S.c. 676 N St Clair Suite 2250 Chicago IL 60611-0075 Ph: (312) 926-0888 | Elisabeth I. Wallner, M.d., S.c. 676 N St Clair Suite 2250 Chicago IL 60611 Ph: (312) 926-0888 |
| NPI Number | 1396915955 |
|---|---|
| Provider Enumeration Date | 03/10/2008 |
| Last Update Date | 05/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396915955 | NPI | - | NPPES |
| 001627372 | Other | IL | BLUE CROSS BLUE SHIELD |
| 9750416 | Other | IL | CIGNA |
| 036089720 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 36089720 (Illinois) | Primary |
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