Provider Demographics
NPI:1902947955
Name:WURTZ, REBECCA MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARION
Last Name:WURTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2112 W LUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4816
Mailing Address - Country:US
Mailing Address - Phone:773-743-4213
Mailing Address - Fax:773-761-7546
Practice Address - Street 1:2112 W LUNT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4816
Practice Address - Country:US
Practice Address - Phone:773-743-4213
Practice Address - Fax:773-761-7546
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease