Provider Demographics
NPI:1821164492
Name:WERBER, JOAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:WERBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:WERBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:60 EAST DELAWARE PLACE
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6559
Mailing Address - Country:US
Mailing Address - Phone:312-867-9000
Mailing Address - Fax:312-867-9127
Practice Address - Street 1:60 EAST DELAWARE PLACE
Practice Address - Street 2:SUITE 1410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6559
Practice Address - Country:US
Practice Address - Phone:312-867-9000
Practice Address - Fax:312-867-9127
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062483174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
671740Medicare ID - Type Unspecified
C39691Medicare UPIN