Provider Demographics
NPI:1740497833
Name:F.A. WRESTLER M.D., LTD
Entity type:Organization
Organization Name:F.A. WRESTLER M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WRESTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-355-8880
Mailing Address - Street 1:501 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5565
Mailing Address - Country:US
Mailing Address - Phone:217-355-8880
Mailing Address - Fax:217-355-8883
Practice Address - Street 1:501 S 6TH ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5565
Practice Address - Country:US
Practice Address - Phone:217-355-8880
Practice Address - Fax:217-355-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL444570Medicare ID - Type Unspecified
ILF01988Medicare UPIN