Provider Demographics
NPI:1295037703
Name:WETTSTEIN, DEE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEE ANNE
Middle Name:
Last Name:WETTSTEIN
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 1:709 S HILLDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-1528
Mailing Address - Country:US
Mailing Address - Phone:309-824-2242
Mailing Address - Fax:
Practice Address - Street 1:709 S HILLDALE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1528
Practice Address - Country:US
Practice Address - Phone:309-824-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-064875174400000X
FLME 45598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist