MEDICARE: DR. TERRANCE WEEDEN X DO

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
1	208000000X	Pediatrics Physician	036-152951	IL
2	2080A0000X	Pediatric Adolescent Medicine Physician	036.152951	IL

General Provider Information

NPI Number	:	1407388648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRANCE WEEDEN X DO

Provider Business Mailing Address
First Line	:	1645 W JACKSON BLVD STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3227
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W JACKSON BLVD STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3227
Country	:	US
Telephone Number	:	312-942-3034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	04/13/2026

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Directions to “ DR. TERRANCE WEEDEN X DO” Practice Location

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