MEDICARE: REGIS J WEISS M.D.

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	207VX0201X	Gynecologic Oncology Physician	036-090146	IL

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	:	1588661318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGIS J WEISS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-0909
Country	:	US
Telephone Number	:	847-956-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 N WESTMORELAND RD
Second Line	:	SUITE 306
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1659
Country	:	US
Telephone Number	:	847-956-8700
Fax Number	:	847-888-9609

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/02/2010

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