DR. HERSHEL WIX JR. (NPI# 1962457101) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962457101 |
| Entity Type | Individual |
| Full Name | DR. HERSHEL WIX JR. |
| Credential | M.D. |
| Practice Address |
475 Brown Blvd Suite 103 Bourbonnais IL 60914 |
| Mailing Address |
475 Brown Blvd Suite 103 Bourbonnais IL 60914-2325 |
| Practice Telephone | 8159379370 |
| Practice Fax Number | 8159372700 |
| Mailing Telephone | 8159379370 |
| Mailing Fax Number | 8159372700 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-08-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036051497 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036051497 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 Provena Way Ste C, Bourbonnais, IL 609144798 | 8159363200 | 8159363203 |
| 1710 W Court St, Kankakee, IL 609013160 | 8159363200 | 8159363203 |
| Street Address |
475 BROWN BLVD SUITE 103 |
| City | BOURBONNAIS |
| State | IL |
| Zip Code | 60914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669472262 | David Scott Chudwin | Allergy & Immunology | 475 Brown Blvd, Bourbonnais, IL 60914-2325 | 2005-07-26 |
| 1053672832 | Tower Plaza Neurology Sc | Psychiatry & Neurology | 475 Brown Blvd, Suite 101, Bourbonnais, IL 60914-2325 | 2012-06-07 |
| 1821398439 | Tallgrass Cardiology Services Sc | Internal Medicine | 475 Brown Blvd, Suite 103, Bourbonnais, IL 60914-2325 | 2010-10-28 |
| 1205965936 | Michael John Sergeant Sr. | Psychiatry & Neurology | 475 Brown Blvd, Suite 101, Bourbonnais, IL 60914-2325 | 2007-03-06 |
| 1588706733 | Retina of Illinois, S.c. | Ophthalmology | 475 Brown Blvd, Suite 109, Bourbonnais, IL 60914-2325 | 2007-02-13 |
| 1629152574 | Five Apples Inpatient Specialists | Internal Medicine | 475 Brown Blvd, Ste 103, Bourbonnais, IL 60914 | 2006-10-25 |
| 1588779516 | Riverview Pharmacies Inc | Pharmacy | 475 Brown Blvd, Suite 105, Bourbonnais, IL 60914-2325 | 2006-08-20 |
| 1437175148 | Jennifer Pablo Nepomuceno | Family Medicine | 475 Brown Blvd, Suite 106, Bourbonnais, IL 60914-2325 | 2006-07-14 |
| 1447283692 | Reynaldo Elazegui Nepomuceno | Family Medicine | 475 Brown Blvd, Suite 106, Bourbonnais, IL 60914-2325 | 2006-07-09 |
| 1376536615 | Avtar K Razdan I | Pediatrics | 475 Brown Blvd, Suite 102, Bourbonnais, IL 60914-2325 | 2005-08-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648023 | Jacob Daniel Ledesma | Physical Therapist | 588 William R Latham Senior Dr Ste 5, Bourbonnais, IL 60914 | 2020-10-30 |
| 1467069823 | Alicia Nicole Kendra | Nurse Practitioner | Upliftedcare, 482 Main St. Nw, Bourbonnais, IL 60914 | 2020-09-29 |
| 1043860877 | Victor Manuel Vazquez Cervantes | Pharmacist | 2080 No, Il-50, Bourbonnais, IL 60914 | 2019-09-13 |
| 1740843267 | Panoptic Physical Therapy LLC | Physical Medicine & Rehabilitation | 1511 N. Convent St Suite 1000, Bourbonnais, IL 60914 | 2019-04-19 |
| 1770074577 | Colin P Koerner | Physical Therapist | 215 N Convent St Ste 6, Bourbonnais, IL 60914 | 2018-05-29 |
| 1306337340 | Megan Hoskins | Behavior Technician | 3187 N 2420 W Rd., Bourbonnais, IL 60914 | 2018-05-25 |
| 1932600459 | Thomas H George Dds PC | Clinic/Center | 14 Briarcliff Professional Center, Bourbonnais, IL 60914 | 2018-02-21 |
| 1780193904 | Kathleen M Saindon II | Speech-Language Pathologist | 1021 Deer Trail, Bourbonnais, IL 60914 | 2017-09-20 |
| 1457870206 | Janet Mary Notton | Speech-Language Pathologist | 920 W Margaret Lane, Bourbonnais, IL 60914 | 2017-09-13 |
| 1134646375 | Sagar Batish | Student in an Organized Health Care Education/Training Program | 1096 Country Lane, Bourbonnais, IL 60914 | 2017-08-28 |
| Find all providers in zip 60914 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821398439 | Tallgrass Cardiology Services Sc | Internal Medicine | 475 Brown Blvd, Suite 103, Bourbonnais, IL 60914-2325 | 2010-10-28 |
| 1659406510 | Suresh H Wadhwani | Internal Medicine | 100 Provena Way, Bourbonnais, IL 60914-4796 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528596350 | Stat Cardiologist Inc | Internal Medicine | 2425 W 22nd St Ste 209, Oak Brook, IL 60523-4655 | 2017-05-24 |
| 1306296074 | Safwan Gaznabi | Internal Medicine | Northshore University Healthsystem, Office of Academic Affairs 2650 Ridge Ave., Suite 1304, Evanston, IL 60201 | 2016-06-14 |
| 1154796290 | Ray Jean Pensinger | Internal Medicine | 105 S. Fleming Rd., Woodstock, IL 60098-7903 | 2015-12-01 |
| 1073905311 | Cardio Medical Center Sc | Internal Medicine | 7746 West Madison Ave, Forrest Park, IL 60131 | 2015-02-24 |
| 1427457399 | Charles Joseph Frahm | Internal Medicine | 1200 E Madison Park, Chicago, IL 60615-2961 | 2014-08-17 |
| 1225447725 | Jeremy R. Estrada | Internal Medicine | 5841 S Maryland Ave # Mc5841, Chicago, IL 60637-1447 | 2014-08-08 |
| 1285049197 | Nidhi Madan | Internal Medicine | 1717 W Congress Pkwy Ste 317, Chicago, IL 60612 | 2014-06-30 |
| 1295159184 | Ca Group, LLC | Internal Medicine | 4017 Illinois Route 159, Suite 101, Smithton, IL 62285 | 2014-02-12 |
| 1457788424 | Chicago Vascular Clinic Ltd | Internal Medicine | 812 E Woodfield Rd, Schaumburg, IL 60173-4714 | 2013-10-04 |
| 1942634688 | Vein Md Consultants, LLC | Internal Medicine | 1865 N. Eltnor Blvd., West Chicago, IL 60185-5900 | 2013-08-29 |
| Find all providers with the same taxonomy | ||||
| City | BOURBONNAIS |
| Zip Code | 60914 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.