Provider Demographics
NPI:1962457101
Name:WIX, HERSHEL L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSHEL
Middle Name:L
Last Name:WIX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21407 W COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-8746
Mailing Address - Country:US
Mailing Address - Phone:815-216-0186
Mailing Address - Fax:
Practice Address - Street 1:151 W HIGH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1407
Practice Address - Country:US
Practice Address - Phone:815-705-1000
Practice Address - Fax:815-705-2709
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036051497207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051497Medicaid
IL036051497Medicaid