Provider Demographics
NPI:1609187590
Name:WIERZBICKI, JACLYN BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:BETH
Last Name:WIERZBICKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-668-0833
Practice Address - Fax:630-208-4373
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43580208600000X
IL036143159208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery