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General NPI Number Information
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NPI Number | 1093907727
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Entity Type | Organization
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Legal Business Name | TERRIE L WEIR MEDICAL PC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 7605 1/2 NORTH AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1133
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Country | US
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Telephone | 708-366-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 7605 1/2 NORTH AVE
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City | RIVER FOREST
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State | IL
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Zip | 60305-1133
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Country | US
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Telephone | 708-366-4888
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRIE L WEIR
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Credential | MD
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Telephone | 708-366-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 036081633
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License Number State | IL
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