Individual
GARY WAINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6840 WINDSOR AVE, BERWYN, IL 60402-3441
(708) 484-0042
(708) 749-5489
Mailing address
1415 W 22ND ST, OAK BROOK, IL 60523-2074
(630) 933-5103
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036060677
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036060677
—
IL
Enumeration date
05/31/2005
Last updated
12/27/2017
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