Healthcare Provider Details

I. General information

NPI: 1245526680
Provider Name (Legal Business Name): WEILI ZHANG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E GRANT ST SUITE 213
MACOMB IL
61455-3368
US

IV. Provider business mailing address

515 E GRANT ST SUITE 213
MACOMB IL
61455-3368
US

V. Phone/Fax

Practice location:
  • Phone: 309-833-4101
  • Fax: 309-836-1547
Mailing address:
  • Phone: 309-833-4101
  • Fax: 309-836-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG154577
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036135529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: