Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125074475 | IL |
NPI | 1023678638 |
---|---|
Provider Name | Matthew Weber |
First Address | Springfield, IL 62794-9638 |
Second Address | Springfield, IL 61702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/06/2019 |