Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-116309 | IL |
N | 111NI0900X | Internist | 036-116309 | IL |
Y | 207RR0500X | Rheumatology | 036116309 | IL |
NPI | 1083771711 |
---|---|
Provider Name | Dr. Corinna Elisabeth Sophie Weckerle |
First Address | Winfield, IL 60190-1295 |
Second Address | Winfield, IL 60190-1295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116309 | (05) | IL |
920540 | MEDICARE PTAN (GROUP) (01) | |
920540010 | MEDICARE PTAN (INDIVIDUAL) (01) | |
CE8792 | RAILROAD MEDICARE PTAN (GROUP) (01) | IL |
P01090240 | RAILROAD MEDICARE PTAN (INDIVIDUAL) (01) | IL |