NPI 1003143504

Bernadeta Leegan Wibisono, MD

Practitioner Pediatrics Physician Chicago, IL

Practice location

Address: 2951 S King Dr APT 1004, Chicago, IL 60616-3359
Phone: (312) 351-1346

Registered specialties

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 125055427 (IL)

Other Pediatrics providers in Illinois →

Registry record

NPI: 1003143504
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Nov 2009
Record last updated: 4 Nov 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.