Provider Demographics
NPI:1598982571
Name:EAR INSTITUTE OF CHICAGO LLC
Entity type:Organization
Organization Name:EAR INSTITUTE OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-789-3110
Mailing Address - Street 1:11 SALT CREEK LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2902
Mailing Address - Country:US
Mailing Address - Phone:630-789-3110
Mailing Address - Fax:630-789-3137
Practice Address - Street 1:11 SALT CREEK LN
Practice Address - Street 2:SUITE 101
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2902
Practice Address - Country:US
Practice Address - Phone:630-789-3110
Practice Address - Fax:630-789-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047459207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232139OtherBCBS
IL036085232Medicaid
IL040017598OtherRR MEDICARE
IL036085232Medicaid
216273Medicare PIN