Individual
ELISE WESSOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
204 W UNIVERSITY AVE, URBANA, IL 61801-1741
(217) 383-6039
(217) 328-3581
Mailing address
611 W PARK, FAPC, URBANA, IL 61802
(217) 902-6954
(217) 902-7711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036150604
IL
207Q00000X
Family Medicine Physician
125.067468
IL
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
036150604
IL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
036-150604
IL
Other
Enumeration date
06/18/2015
Last updated
12/24/2024
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