Individual
JOHN ARTHUR WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5300 W DIVERSEY AVE, CHICAGO, IL 60639-1513
(773) 725-0990
Mailing address
5300 W DIVERSEY AVE, CHICAGO, IL 60639-1513
(773) 725-0990
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036-069176
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004531987
AETNA
IL
01
—
0031601867
BLUE SHIELD
IL
05
—
036069176
—
IL
Enumeration date
05/03/2006
Last updated
06/30/2008
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