Organization
IV LEAGUE HYDRATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON PAUL WISINSKI DO (MEDICAL DIRECTOR)
(815) 529-5949
Entity
Organization
Contact information
Practice address
1515 S PRAIRIE AVE UNIT 411, CHICAGO, IL 60605-3019
(815) 529-5949
Mailing address
1515 S PRAIRIE AVE UNIT 411, CHICAGO, IL 60605-3019
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/09/2025
Last updated
08/09/2025
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