Provider Demographics
NPI:1609889690
Name:WILSBACHER, LISA DIANE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DIANE
Last Name:WILSBACHER
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Gender:F
Credentials:MD PHD
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Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:GALTER SUITE 19-100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-664-3278
Mailing Address - Fax:312-695-5774
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER SUITE 19-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-664-3278
Practice Address - Fax:312-695-5774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2015-03-16
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Provider Licenses
StateLicense IDTaxonomies
IL036137176207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine