Individual
DR. GARY G WIESMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
712 N DEARBORN ST, CHICAGO, IL 60654-3846
(312) 796-5550
(312) 981-1292
Mailing address
712 N DEARBORN ST, CHICAGO, IL 60654-3846
(312) 796-5550
(312) 981-1292
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
036042623
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621610
BCBS
IL
05
—
036042623
—
IL
Enumeration date
09/07/2006
Last updated
04/09/2020
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