Provider Demographics
NPI:1215143250
Name:PAULINE K. WIENER, M.D., S.C.
Entity type:Organization
Organization Name:PAULINE K. WIENER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-682-2746
Mailing Address - Street 1:1N681 BOB O LINK DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2326
Mailing Address - Country:US
Mailing Address - Phone:630-682-2746
Mailing Address - Fax:630-681-8657
Practice Address - Street 1:27W350 HIGH LAKE RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1262
Practice Address - Country:US
Practice Address - Phone:630-682-2746
Practice Address - Fax:630-681-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty