Provider Demographics
NPI:1942399761
Name:WURSTER, SAMUEL HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HOWARD
Last Name:WURSTER
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 1:980 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1417
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4501
Mailing Address - Country:US
Mailing Address - Phone:312-214-3656
Mailing Address - Fax:
Practice Address - Street 1:980 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1417
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4501
Practice Address - Country:US
Practice Address - Phone:312-214-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery