MEDICARE: KATIE K WEINER PA-C

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	363AS0400X	Surgical Physician Assistant	085003686	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085003686	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1750612297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE K WEINER PA-C

Provider Business Mailing Address
First Line	:	880W CENTRAL RD 5000
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-618-3800
Fax Number	:	847-618-3809

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD
Second Line	:	SUITE 3800
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2369
Country	:	US
Telephone Number	:	847-483-9800
Fax Number	:	847-483-9808

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

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	05/25/2021

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Directions to “ KATIE K WEINER PA-C” Practice Location

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