Provider Demographics
NPI:1871503623
Name:WICHTER, MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:
Last Name:WICHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:708-361-0222
Practice Address - Fax:708-361-4536
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360555692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055569Medicaid
ILK02580Medicare ID - Type Unspecified