Mervyn J. Weis
Internist Gastroenterologist
4640 N Marine Dr Suite 6100c
Chicago
, Illinois 60640-5719
Mervyn J. Weis
Internist Gastroenterologist
4640 N Marine Dr Suite 6100c
Chicago
, Illinois 60640-5719
(773) 769-5140
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About
Features
Specialties
- Internist
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Mervyn J. Weis
- 4640 N Marine Dr Suite 6100c
- Chicago, IL
- Zip : 60640-5719
- Fax : (773) 769-5140
- Phone : (773) 769-4411
Second Address
- Mervyn J. Weis
- 4640 N Marine Dr Suite 6100c
- Chicago, IL
- Zip : 60640-5719
- Fax : (773) 769-5140
- Phone : (773) 769-4411
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | IL | |
| N | 111NI0900X | Internist | IL | |
| N | 207RG0100X | Gastroenterologist | IL |
National Provider Identifier
| NPI | 1043212954 |
|---|---|
| Provider Name | Mervyn J. Weis |
| First Address | Chicago, IL 60640-5719 |
| Second Address | Chicago, IL 60640-5719 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/08/2005 |
| Last Update Date | 09/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 01615327 | BLUE CROSS (01) | IL |
| 36040513 | IL LICENSE NUMBER (01) | IL |
| AW3666469 | DEA LICENSE NUMBER (01) | IL |
| D12456 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.