Healthcare Provider Details

I. General information

NPI: 1659953172
Provider Name (Legal Business Name): ASHLEE MARIE WEAVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC1052
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

6469 TARA DR
POLAND OH
44514-5608
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6760
  • Fax:
Mailing address:
  • Phone: 330-207-4429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number036.176083
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: