Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Bernadeta Leegan Wibisono, MD

Individual provider Pediatrics Physician · NPI 1003143504

Bernadeta Leegan Wibisono, MD is a Pediatrics Physician in Chicago, Illinois. Practices as a sole proprietor. Licensed in Illinois.

Licensed in
IL
In the registry since
2009
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2951 S King Dr Apt 1004
Chicago, IL 60616-3359
Phone: (312) 351-1346
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 125055427 (IL)

Record details

NPI number1003143504
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedNovember 4, 2009
Last updated in NPPESNovember 4, 2009

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