Individual
CHRISTIAN SAMUEL WIRAWAN
Active
Individual
CHRISTIAN SAMUEL WIRAWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
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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