Provider Demographics
NPI:1861435927
Name:WIENER, MARC L (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27W170 SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1935
Mailing Address - Country:US
Mailing Address - Phone:630-562-9100
Mailing Address - Fax:630-562-9172
Practice Address - Street 1:27W170 SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1935
Practice Address - Country:US
Practice Address - Phone:630-562-9100
Practice Address - Fax:630-562-9172
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL002220114OtherBCBS NUMBER
IL056076864Medicaid
IL002220114OtherBCBS NUMBER
IL056076864Medicaid