Provider Demographics
NPI:1124106067
Name:WOOSENCRAFT, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WOOSENCRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 N HALSTED ST
Mailing Address - Street 2:APT 3S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9242
Mailing Address - Country:US
Mailing Address - Phone:608-217-1391
Mailing Address - Fax:
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:SUITE 703
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-772-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.126113207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology