Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 125.073090 | IL |
NPI | 1023513850 |
---|---|
Provider Name | Jeffrey Ryan Weishaar |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2018 |
Last Update Date | 11/07/2018 |