Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016002670 | IL |
Y | 222Z00000X | Podiatrist | 016002670 | IL |
NPI | 1043362189 |
---|---|
Provider Name | Dr. Robert A Weil |
First Address | Aurora, IL 60504 |
Second Address | Aurora, IL 60504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60000761 | BCBS PROVIDER (01) | |
T35490 | (02) |