Healthcare Provider Details

I. General information

NPI: 1861447484
Provider Name (Legal Business Name): RICHARD HARVEY WEINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST HURON SUITE 12-260 GALTER PAVILION
CHICAGO IL
60611
US

IV. Provider business mailing address

201 EAST HURON SUITE 12-260 GALTER PAVILION
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-9570
  • Fax: 312-926-6776
Mailing address:
  • Phone: 312-926-9570
  • Fax: 312-926-6776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: