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General NPI Number Information
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NPI Number | 1386754125
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Entity Type | Individual
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Provider Name | PETER WEIDEN MD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 912 S WOOD ST UIC PSYCHIATRY MC913
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 312-996-6557
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Fax | 312-996-9517
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Provider Business Mailing Address
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Address Line | 230 E DELAWARE PL 5W
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City | CHICAGO
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State | IL
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Zip | 60611-5763
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Country | US
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Telephone | 312-280-5947
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 150916
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License Number State | NY
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