MEDICARE: DR. GRETCHEN M WEISS MD

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	207R00000X	Internal Medicine Physician	036115176	IL
2	207R00000X	Internal Medicine Physician	60694	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528049491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN M WEISS MD

Provider Business Mailing Address
First Line	:	10 ROCKEFELLER PLZ
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10020-1903
Country	:	US
Telephone Number	:	212-332-3670
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 W MADISON ST
Second Line	:	SUITE 4550
City	:	CHICAGO
State	:	IL
Zip	:	60602-4510
Country	:	US
Telephone Number	:	312-641-2586
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	12/01/2008

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