Provider Demographics
NPI:1235214982
Name:NIEVES NEIRA, WILBERTO (MD)
Entity Type:Individual
Prefix:
First Name:WILBERTO
Middle Name:
Last Name:NIEVES NEIRA
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 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE #1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-0050
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:SUITE 05-2168 GYNECOLOGIC ONCOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-695-0990
Practice Address - Fax:312-472-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07442500207VX0201X
IL036139777207VX0201X
IL036-139777207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8990905Medicaid
IL8990905Medicaid
IL8990905Medicaid
NJ8990905Medicaid
ILG69362Medicare UPIN
NJ066132P3VMedicare PIN