DRS Wagner-Debre Associates SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036053268 Issued in IL

Legal business name

DRS WAGNER-DEBRE ASSOCIATES SC

Practice address

9830 Ridgeland Ave
Suite 101
Chicago Ridge, IL 60415-2667

Phone

(708) 423-3800

NPI assigned

Dec 17, 2007

Organization subpart

No

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

Authorized official

Name

Michael W Debre, M.D.

Title

Sole Owner (President)

Phone

(708) 423-3800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1841474574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9830 RIDGELAND AVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152667",
            "telephone_number": "708-423-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9830 RIDGELAND AVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152667",
            "telephone_number": "708-423-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS WAGNER-DEBRE ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "DEBRE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SOLE OWNER  (PRESIDENT)",
        "authorized_official_telephone_number": "708-423-3800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036053268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36053268",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eun Kyu Dong
• Yaw N Donkoh, M.D.
• Erin Doody
• Tiaressa N Doyle, LCPC
• Dr. Raina & Associtates (Chicago Ridge), LTD
• Quinesha Edwards
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• Elevated Groups Counseling LLC
• Jade Enriquez

• Internal Medicine Physician in Chicago Ridge, IL
• Providers in Chicago Ridge, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; 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.