Healthcare Provider Details

I. General information

NPI: 1841451549
Provider Name (Legal Business Name): CHRISTINE WEIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ERIE CT STE 6160 FAMILY MEDICINE CENTER
OAK PARK IL
60302-2510
US

IV. Provider business mailing address

1 ERIE CT STE 6160 FAMILY MEDICINE CENTER
OAK PARK IL
60302-2510
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-1490
  • Fax: 708-763-2394
Mailing address:
  • Phone: 708-763-1490
  • Fax: 708-763-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125051216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: