Organization
INSTITUTE FOR PERSONAL DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD WUEST MD (MEDICAL DIRECTOR)
(815) 942-6323
Entity
Organization
Contact information
Practice address
1401 LAKEWOOD DR, SUITE A, MORRIS, IL 60450-3352
(815) 942-6323
(630) 545-3004
Mailing address
PO BOX 7410264, CHICAGO, IL 60674-0264
(815) 922-8290
(630) 545-3004
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
IL
2084P0800X
Psychiatry Physician
036075773
IL
2084P0800X
Psychiatry Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383120
MEDICARE PIN
IL
Enumeration date
06/01/2006
Last updated
10/31/2022
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