Healthcare Provider Details

I. General information

NPI: 1780656793
Provider Name (Legal Business Name): PHILIP J WEBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 CENEX DR - MAIL STOP 33100A HEALTH PARTNERS INVER GROVE HEIGHTS CLINIC
INVER GROVE HEIGHTS MN
55077-1735
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-552-2600
  • Fax: 651-552-2614
Mailing address:
  • Phone: 952-883-5375
  • Fax: 651-552-2614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33373
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: