Provider Demographics
NPI:1366616716
Name:THERESA WEILAND DO PA
Entity type:Organization
Organization Name:THERESA WEILAND DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-333-8841
Mailing Address - Street 1:2245 TOLUKA WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-345-7727
Practice Address - Fax:208-345-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty