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General NPI Number Information
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NPI Number | 1043212954
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Entity Type | Individual
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Provider Name | MERVYN J. WEIS MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4640 N MARINE DR SUITE 6100C
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City | CHICAGO
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State | IL
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Zip | 60640-5719
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Country | US
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Telephone | 773-769-4411
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Fax | 773-769-5140
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Provider Business Mailing Address
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Address Line | 4640 N MARINE DR SUITE 6100C
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City | CHICAGO
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State | IL
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Zip | 60640-5719
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Country | US
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Telephone | 773-769-4411
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Fax | 773-769-5140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | IL
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