Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 125.075503 | IL |
NPI | 1053938035 |
---|---|
Provider Name | Dr. Grace Helene Wegrzyn |
First Address | Chicago, IL 60612-3714 |
Second Address | Chicago, IL 60612-3714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2020 |
Last Update Date | 25/06/2020 |