Provider Demographics
NPI:1396193454
Name:WATERMAN, HELEN GERSENY (DO)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:GERSENY
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4004
Mailing Address - Country:US
Mailing Address - Phone:773-348-8300
Mailing Address - Fax:
Practice Address - Street 1:2900 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4004
Practice Address - Country:US
Practice Address - Phone:773-348-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6160-851208000000X
WI68057208000000X
IL036.152851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics