MEDICARE: RALPH R WEICHSELBAUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	34518	MA

General Provider Information

NPI Number	:	1578510749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH R WEICHSELBAUM M.D.

Provider Business Mailing Address
First Line	:	5758 S.MARYLAND, MC 9006-DCAM
Second Line	:	U. OF CHICAGO/RADIATION& ONCOL
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:	773-702-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	5758 S MARYLAND AVE
Second Line	:	MC9006
City	:	CHICAGO
State	:	IL
Zip	:	60637-1426
Country	:	US
Telephone Number	:	773-702-0817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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