Individual
DR. IRVIN MICHAEL WIESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
712 N DEARBORN ST, CHICAGO, IL 60654-3818
(312) 981-1290
(312) 981-1292
Mailing address
712 N DEARBORN ST, CHICAGO, IL 60654-3818
(312) 981-1290
(312) 981-1292
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036095961
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633365
BCBS
—
05
—
036095961
—
IL
Enumeration date
11/14/2006
Last updated
06/11/2015
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