Organization
ELISABETH I. WALLNER, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELISABETH I WALLNER M.D. (PRESIDENT)
(312) 926-0888
Entity
Organization
Contact information
Practice address
676 N ST CLAIR, SUITE 2250, CHICAGO, IL 60611
(312) 926-0888
(312) 926-0889
Mailing address
676 N ST CLAIR, SUITE 2250, CHICAGO, IL 60611-0075
(312) 926-0888
(312) 926-0889
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
36089720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001627372
BLUE CROSS BLUE SHIELD
IL
05
—
036089720
—
IL
01
—
9750416
CIGNA
IL
Enumeration date
03/10/2008
Last updated
05/08/2012
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