Healthcare Provider Details

I. General information

NPI: 1609398825
Provider Name (Legal Business Name): ROBERT WEISS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT WEISS MD

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST STE 550
PARK RIDGE IL
60068-1188
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-384-1420
  • Fax: 847-318-9332
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT213930
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036158818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: