Dr. Gary G Wiesman
Otolaryngology/Facial Plastic Surgery
712 N Dearborn St
Chicago
, Illinois 60654-3846
Dr. Gary G Wiesman
Otolaryngology/Facial Plastic Surgery
712 N Dearborn St
Chicago
, Illinois 60654-3846
(312) 981-1292
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About
Features
Specialties
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Dr. Gary G Wiesman
- 712 N Dearborn St
- Chicago, IL
- Zip : 60654-3846
- Fax : (312) 981-1292
- Phone : (312) 796-5550
Second Address
- Dr. Gary G Wiesman
- 712 N Dearborn St
- Chicago, IL
- Zip : 60654-3846
- Fax : (312) 981-1292
- Phone : (312) 796-5550
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036042623 | IL |
National Provider Identifier
| NPI | 1821191404 |
|---|---|
| Provider Name | Dr. Gary G Wiesman |
| First Address | Chicago, IL 60654-3846 |
| Second Address | Chicago, IL 60654-3846 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/09/2006 |
| Last Update Date | 09/04/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 01621610 | BCBS (01) | IL |
| 036042623 | (05) | IL |
| C42073 | (02) |
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.