Individual
DR. LEXY WISTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6131 DEMPSTER ST, MORTON GROVE, IL 60053-2953
(847) 967-5010
(847) 967-5147
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
(847) 967-5147
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036082382
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632926
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/08/2005
Last updated
05/12/2022
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