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General NPI Number Information
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NPI Number | 1689820524
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Entity Type | Individual
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Provider Name | MICHAEL G WEINBERG D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 1475 N DILLEYS ROAD SUITE 1
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City | GURNEE
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State | IL
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Zip | 60031-5305
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Country | US
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Telephone | 847-249-8800
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Fax | 847-249-8869
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Provider Business Mailing Address
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Address Line | 1475 N DILLEYS RD SUITE 1
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City | GURNEE
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State | IL
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Zip | 60031-1708
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Country | US
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Telephone | 847-249-8800
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Fax | 847-249-8869
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019023009
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License Number State | IL
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