Provider Demographics
NPI:1417153651
Name:BISGROVE, JOANNA TURNER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:TURNER
Last Name:BISGROVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:RACHEL
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5191
Mailing Address - Country:US
Mailing Address - Phone:773-472-3704
Mailing Address - Fax:608-835-1090
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5191
Practice Address - Country:US
Practice Address - Phone:773-472-3704
Practice Address - Fax:608-835-1090
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50489-020207Q00000X
IL036115902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417153651Medicaid
WI34920100Medicaid
WI100674150Medicare PIN
WIP00432250Medicare PIN
WI044554340Medicare PIN