Provider Demographics
NPI:1629147129
Name:WILBER, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:WILBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:630-627-7399
Mailing Address - Fax:630-627-7079
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:630-627-7399
Practice Address - Fax:630-627-7079
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-057219207R00000X
IL036057219207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16122Medicare UPIN
IL908250Medicare ID - Type Unspecified