Healthcare Provider Details

I. General information

NPI: 1487146486
Provider Name (Legal Business Name): MATTHEW WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD
GLENVIEW IL
60026-1301
US

IV. Provider business mailing address

4901 SEARLE PKWY STE 150
SKOKIE IL
60077-5320
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-5887
  • Fax:
Mailing address:
  • Phone: 847-982-3363
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.157083
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036.157083
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: