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NPI Code Detail

MEDICARE: RONALD WEGLARZ PSYD

MEDICARE: RONALD WEGLARZ PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1386775856
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD WEGLARZ PSYD
Provider Business Mailing Address
First Line : 19530 KEDZIE AVE
Second Line :
City : FLOSSMOOR
State : IL
Zip : 60422-1778
Country : US
Telephone Number : 708-799-2200
Fax Number : 708-799-2711
Provider Business Practice Location Address
First Line : 19530 KEDZIE AVE
Second Line :
City : FLOSSMOOR
State : IL
Zip : 60422-1778
Country : US
Telephone Number : 708-799-2200
Fax Number : 708-799-2711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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