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General NPI Number Information
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NPI Number | 1710239439
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Entity Type | Organization
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Legal Business Name | DANIEL WEISSBLUTH, M.D, S.C
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE SUITE 820
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City | CHICAGO
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State | IL
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Zip | 60611-2615
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Country | US
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Telephone | 312-202-0300
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Fax | 312-202-0383
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Provider Business Mailing Address
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Address Line | 737 N MICHIGAN AVE SUITE 820
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City | CHICAGO
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State | IL
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Zip | 60611-2615
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Country | US
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Telephone | 312-202-0300
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Fax | 312-202-0383
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DANIEL D. WEISSBLUTH
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Credential | M.D
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Telephone | 312-202-0300
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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 | 036122082
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License Number State | IL
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