Provider Demographics
NPI:1720090707
Name:WRESTLER, FRANK ALAN (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:ALAN
Last Name:WRESTLER
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 1:501 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5565
Mailing Address - Country:US
Mailing Address - Phone:217-355-8880
Mailing Address - Fax:217-355-8883
Practice Address - Street 1:501 S 6TH ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5565
Practice Address - Country:US
Practice Address - Phone:217-355-8880
Practice Address - Fax:217-355-8883
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360640461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360640461Medicaid
IL444570Medicare ID - Type Unspecified
IL0360640461Medicaid