Provider Demographics
NPI:1215195433
Name:CRONENWETT, WILL J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILL
Middle Name:J
Last Name:CRONENWETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E ONTARIO ST FL 6
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7105
Mailing Address - Country:US
Mailing Address - Phone:312-926-8638
Mailing Address - Fax:
Practice Address - Street 1:446 E ONTARIO ST FL 6
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7105
Practice Address - Country:US
Practice Address - Phone:312-926-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361171092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry