Provider Demographics
NPI:1598701625
Name:WOHL, LISA G (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:G
Last Name:WOHL
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:303 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2169
Practice Address - Country:US
Practice Address - Phone:630-351-2030
Practice Address - Fax:630-351-3983
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36060734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060734Medicaid
IL049603001OtherDMERC
IL02215680OtherBLUE CROSS BLUE SHIELD
IL180012516OtherRAILROAD MEDICARE
ILC47334Medicare UPIN
IL0496030001Medicare NSC
ILL54108Medicare ID - Type Unspecified
IL02215680OtherBLUE CROSS BLUE SHIELD
IL1174666432Medicare NSC