Provider Demographics
NPI:1073680187
Name:WIENER, PAULINE K (MD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:K
Last Name:WIENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:630-231-9400
Mailing Address - Fax:630-231-2736
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:630-231-9400
Practice Address - Fax:630-231-2736
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360883342084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL260027994OtherRAILROAD MEDICARE
IL036088334Medicaid
ILE78071Medicare UPIN
IL036088334Medicaid