Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 036-094579 | IL |
Y | 2086S0127X | Trauma Surgeon | 036-094579 | IL |
NPI | 1083733075 |
---|---|
Provider Name | Dr. Dorion Elizabeth Wiley |
First Address | Chicago, IL 60637-1721 |
Second Address | Chicago, IL 60612-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H76342 | (02) | IL |