Individual
WILBERTO NIEVES NEIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 E SUPERIOR ST, SUITE 05-2168 GYNECOLOGIC ONCOLOGY, CHICAGO, IL 60611-2914
(312) 695-0990
(312) 472-4706
Mailing address
680 N LAKE SHORE DR, SUITE #1000, CHICAGO, IL 60611-4546
(312) 695-0665
(312) 695-0050
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036-139777
IL
207VX0201X
Gynecologic Oncology Physician
Primary
036139777
IL
207VX0201X
Gynecologic Oncology Physician
25MA07442500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8990905
—
IL
05
—
8990905
—
NJ
Enumeration date
10/25/2006
Last updated
04/28/2021
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