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General NPI Number Information
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NPI Number | 1134226145
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Entity Type | Individual
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Provider Name | MATTHEW J WEIDMAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 2028 N SEMINARY ST
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City | GALESBURG
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State | IL
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Zip | 61401
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Country | US
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Telephone | 309-647-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 W AGENCY RD
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1667
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Country | US
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Telephone | 319-753-5177
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036116945
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License Number State | IL
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