Provider Demographics
NPI:1154496552
Name:WISEMAN, COURTNEY LEE NEMETH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE NEMETH
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEE
Other - Last Name:NEMETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 COMMERCE CT
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3709
Mailing Address - Country:US
Mailing Address - Phone:630-305-8545
Mailing Address - Fax:630-305-8549
Practice Address - Street 1:4300 COMMERCE CT
Practice Address - Street 2:SUITE 250
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3709
Practice Address - Country:US
Practice Address - Phone:630-305-8545
Practice Address - Fax:630-305-8549
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1105472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry