Healthcare Provider Details

I. General information

NPI: 1376273276
Provider Name (Legal Business Name): WEIL FOOT AND ANKLE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

120 E 90TH DR
MERRILLVILLE IN
46410-7160
US

IV. Provider business mailing address

1660 FEEHANVILLE DR STE 450
MT PROSPECT IL
60056-6023
US

V. Phone/Fax

Practice location:
  • Phone: 847-390-7666
  • Fax: 847-390-9345
Mailing address:
  • Phone: 847-390-7666
  • Fax: 847-390-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOWELL SCOTT WEIL
Title or Position: CEO
Credential: DPM
Phone: 847-390-7666