Elisabeth I. Wallner, M.D., S.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

36089720 Issued in IL

Legal business name

ELISABETH I. WALLNER, M.D., S.C.

Practice address

676 N St Clair
Suite 2250
Chicago, IL 60611

Phone

(312) 926-0888

Fax

(312) 926-0889

NPI assigned

Mar 10, 2008

Last updated

May 8, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Elisabeth I Wallner, M.D.NPI 1912919440

Title

President

Phone

(312) 926-0888

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elisabeth I Wallner, M.D., M.P.H.

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1912919440
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336435200000",
    "number": "1396915955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N ST CLAIR",
            "address_2": "SUITE 2250",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606110075",
            "telephone_number": "312-926-0888",
            "fax_number": "312-926-0889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N ST CLAIR",
            "address_2": "SUITE 2250",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60611",
            "telephone_number": "312-926-0888",
            "fax_number": "312-926-0889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELISABETH I. WALLNER, M.D., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2012-05-08",
        "status": "A",
        "authorized_official_last_name": "WALLNER",
        "authorized_official_first_name": "ELISABETH",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-926-0888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "36089720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001627372",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9750416",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089720",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.