Individual
MS. ELISABETH I WALLNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
676 N SAINT CLAIR ST, SUITE 2250, CHICAGO, IL 60611-2927
(312) 926-0888
(312) 926-0889
Mailing address
PO BOX 11075, CHICAGO, IL 60611-0075
(312) 926-0888
(312) 926-0889
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36089720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001627372
BLUE CROSS BLUE SHIELD
IL
05
—
036089720
—
IL
01
—
9750416
CIGNA HEALTHCARE
IL
Enumeration date
08/13/2006
Last updated
04/21/2011
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