Healthcare Provider Details

I. General information

NPI: 1639905375
Provider Name (Legal Business Name): WEIL FOOT AND ANKLE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E 47TH ST
CHICAGO IL
60653-4507
US

IV. Provider business mailing address

PO BOX 848195
LOS ANGELES CA
90084-8195
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-7666
  • Fax: 847-390-9345
Mailing address:
  • Phone: 847-627-4920
  • Fax: 847-390-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LOWELL SCOTT WEIL
Title or Position: EXECUTIVE CHAIRMAN
Credential: DPM
Phone: 847-390-7666