| Doctor Name: | LEON WISE |
| NPI Number: | 1023221926 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 036.123706 |
| Business Practice Address: | 111 Spring St St. Mary's Hospital Streator, IL - 613643332 |
| Business Phone Number: | 8156734612 |
| Business Fax Number: | |
| Mailing Address: | 71 W 156th St, Suite 110 HARVEY |
| State: | IL |
| Postal Code: | 604264260 |
| Phone Number: | 7089155671 |
| Fax Number: | 7089154022 |
| NPI Enumeration Date: | 05/07/2007 |
| NPI Last Update Date: | 05/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 036.123706 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |