Individual
CHRISTIAN SAMUEL WIRAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1401 S CALIFORNIA AVE, CHICAGO, IL 60608-1694
(773) 565-3008
Mailing address
1401 S CALIFORNIA AVE STE 1, CHICAGO, IL 60608-1694
(737) 565-3008
(773) 522-5855
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.079572
IL
208D00000X
General Practice Physician
036.171642
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2022
Last updated
09/10/2024
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