Provider Demographics
NPI:1083771711
Name:WECKERLE, CORINNA ELISABETH SOPHIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINNA
Middle Name:ELISABETH SOPHIE
Last Name:WECKERLE
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 1:27650 FERRY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3845
Mailing Address - Country:US
Mailing Address - Phone:630-933-7400
Mailing Address - Fax:630-315-8979
Practice Address - Street 1:27650 FERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3845
Practice Address - Country:US
Practice Address - Phone:630-933-7400
Practice Address - Fax:630-315-8979
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116309207R00000X
IL036116309207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01090240OtherRAILROAD MEDICARE PTAN (INDIVIDUAL)
IL036116309Medicaid
920540010OtherMEDICARE PTAN (INDIVIDUAL)
920540OtherMEDICARE PTAN (GROUP)
ILCE8792OtherRAILROAD MEDICARE PTAN (GROUP)