| Doctor Name: | JEFFREY WIELGOS |
| NPI Number: | 1538588801 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 160004013 |
| Business Practice Address: | 10300 Southwest Hwy Chicago Ridge, IL - 604151426 |
| Business Phone Number: | 7084251100 |
| Business Fax Number: | |
| Mailing Address: | 10300 Southwest Hwy, CHICAGO RIDGE |
| State: | IL |
| Postal Code: | 604151426 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2014 |
| NPI Last Update Date: | 04/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | 160004013 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |