Healthcare Provider Details

I. General information

NPI: 1659349280
Provider Name (Legal Business Name): LEE DAVID WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7234 WEST OGDEN AVENUE SUITE 3N
RIVERSIDE IL
60546-2387
US

IV. Provider business mailing address

1341 WARREN AVENUE
DOWNERS GROVE IL
60515-3437
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-2277
  • Fax: 708-447-2274
Mailing address:
  • Phone: 630-719-5454
  • Fax: 630-719-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036044369
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.044369
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: