Healthcare Provider Details

I. General information

NPI: 1447270475
Provider Name (Legal Business Name): MITCHELL R WEINSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKESHORE DR 12TH FLOOR
CHICAGO IL
60657
US

IV. Provider business mailing address

2900 N LAKESHORE DR 12TH FLOOR
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3261
  • Fax: 773-665-9435
Mailing address:
  • Phone: 773-665-3261
  • Fax: 773-665-9435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036124563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: