Healthcare Provider Details

I. General information

NPI: 1649620519
Provider Name (Legal Business Name): JEFFERY ADAM WEISMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LAKEVIEW DR
BUFFALO GROVE IL
60089-1789
US

IV. Provider business mailing address

301 LAKEVIEW DR
BUFFALO GROVE IL
60089-1789
US

V. Phone/Fax

Practice location:
  • Phone: 847-727-8675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.147683
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036.147683
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036.147683
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036.147683
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036.147683
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number036.147683
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: