Individual
XIMENA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2650 RIDGE AVE STE 1304, EVANSTON, IL 60201-1700
(847) 570-2019
Mailing address
150 HARVESTER DR STE 300, BURR RIDGE, IL 60527-5965
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
125080066
IL
Other
Enumeration date
05/24/2022
Last updated
07/16/2022
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