Bernadeta Leegan Wibisono
Pediatrician
2951 S King Dr Apt 1004
Chicago
, Illinois 60616-3359
Bernadeta Leegan Wibisono
Pediatrician
2951 S King Dr Apt 1004
Chicago
, Illinois 60616-3359
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Bernadeta Leegan Wibisono
- 2951 S King Dr Apt 1004
- Chicago, IL
- Zip : 60616-3359
- Phone :
Second Address
- Bernadeta Leegan Wibisono
- 2951 S King Dr Apt 1004
- Chicago, IL
- Zip : 60616-3359
- Phone : (312) 351-1346
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Is Bernadeta Leegan Wibisono a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 125055427 | IL |
National Provider Identifier
| NPI | 1003143504 |
|---|---|
| Provider Name | Bernadeta Leegan Wibisono |
| First Address | Chicago, IL 60616-3359 |
| Second Address | Chicago, IL 60616-3359 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/11/2009 |
| Last Update Date | 04/11/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.