Individual
DR. BARBARA MAY WIETIES-MALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12935 GREGORY ST, BLUE ISLAND, IL 60406-2428
(708) 597-2000
Mailing address
3300 127TH ST, 2ND FLOOR, BLUE ISLAND, IL 60406-3802
(708) 388-0423
(708) 388-1477
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036068572
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615363
GROUP PIN
IL
05
—
036068572
—
IL
Enumeration date
01/09/2006
Last updated
06/21/2010
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