Healthcare Provider Details

I. General information

NPI: 1760657381
Provider Name (Legal Business Name): HEATHER MAUREEN WEINREICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MAUREEN NELSON

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W TAYLOR ST DEPT OF
CHICAGO IL
60612-7242
US

IV. Provider business mailing address

1855 W TAYLOR ST DEPT OF
CHICAGO IL
60612-7242
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberD0077342
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number036.145671
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: