Healthcare Provider Details

I. General information

NPI: 1962415992
Provider Name (Legal Business Name): RONALD S WEISS MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARLEM AVE
STICKNEY IL
60402-4250
US

IV. Provider business mailing address

4401 HARLEM AVE
STICKNEY IL
60402-4250
US

V. Phone/Fax

Practice location:
  • Phone: 708-788-3400
  • Fax: 708-788-3472
Mailing address:
  • Phone: 708-788-3400
  • Fax: 708-788-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE L NEAL
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 469-214-0144