# GARY WIESMAN MD. LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215180757
- **Authorized official:** DR. GARY G WIESMAN MD (PRESIDENT)
- **Authorized official phone:** (312) 796-5550

## Contact information

- **Practice address:** 712 N DEARBORN ST, CHICAGO, IL 60654-3846
- **Practice address phone:** (312) 796-5550
- **Practice address fax:** (312) 981-1292
- **Mailing address:** 712 N DEARBORN ST, CHICAGO, IL 60654-3846
- **Mailing address phone:** (312) 796-5550
- **Mailing address fax:** (312) 981-1292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | 036042623 | IL | Yes |

## Other

- **Enumeration date:** 10/28/2008
- **Last updated:** 04/10/2020