Provider Demographics
NPI:1063681849
Name:JOHN M. WIELAND, LTD,
Entity Type:Organization
Organization Name:JOHN M. WIELAND, LTD,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MD
Authorized Official - Phone:847-998-9510
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-998-9510
Mailing Address - Fax:847-998-9512
Practice Address - Street 1:3633 WEST LAKE AVE.
Practice Address - Street 2:SUITE 307
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-998-9510
Practice Address - Fax:847-998-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty