Organization
WISE HEALTH PROFESSIONAL CORPORATION
Active
Organization
WISE HEALTH PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHEPHALI PATEL MD (CHIEF OPERATING OFFICER)
(847) 322-9602
Entity
Organization
Contact information
Practice address
4755 N KENMORE AVE, CHICAGO, IL 60640-5015
(773) 989-9868
Mailing address
2600 WYNNCREST DR, LONG GROVE, IL 60047-5033
(847) 322-9602
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036091776
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01637603
BLUE CROSS/BLUE SHIELD
IL
05
—
036091776
—
IL
Enumeration date
10/28/2008
Last updated
11/12/2009
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