MEDICARE: DAVID I. WEISS MD SC

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	042008034036067075	IL

General Provider Information

NPI Number	:	1841582434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID I. WEISS MD SC

Provider Business Mailing Address
First Line	:	4949 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-1921
Country	:	US
Telephone Number	:	847-674-3371
Fax Number	:	847-674-3381

Provider Business Practice Location Address
First Line	:	9129 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2120
Country	:	US
Telephone Number	:	847-674-3371
Fax Number	:	847-674-3381

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID WEISS
Credential	:	M.D.
Telephone Number	:	847-674-3371

Provider Enumeration Date	:	05/14/2011
Last Update Date	:	05/14/2011

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