Provider Demographics
NPI:1326014648
Name:WESTON, JAMES N (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:WESTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:3021 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4419
Practice Address - Country:US
Practice Address - Phone:872-843-0550
Practice Address - Fax:872-873-9070
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00409001OtherMEDICARE RAILROAD
ILP00409001OtherMEDICARE RAILROAD
ILK27620Medicare PIN
IL363062013OtherEIN
ILP00409001OtherMEDICARE RAILROAD