Individual
JAMIE BRENNA WABICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 N WESTMORELAND RD STE 100, LAKE FOREST, IL 60045-1671
(847) 535-6083
Mailing address
800 N WESTMORELAND RD STE 100, LAKE FOREST, IL 60045-1671
(847) 535-6083
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036138232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036138232
ILLINOIS PERMANENT LICENSE
IL
Enumeration date
03/24/2012
Last updated
04/19/2018
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