Healthcare Provider Details

I. General information

NPI: 1093907727
Provider Name (Legal Business Name): TERRIE L WEIR MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 1/2 NORTH AVE
RIVER FOREST IL
60305-1133
US

IV. Provider business mailing address

7605 1/2 NORTH AVE
RIVER FOREST IL
60305-1133
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-4888
  • Fax:
Mailing address:
  • Phone: 708-366-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036081633
License Number StateIL

VIII. Authorized Official

Name: DR. TERRIE L WEIR
Title or Position: PRESIDENT
Credential: MD
Phone: 708-366-7177