Provider Demographics
NPI:1386807212
Name:WEVER, DARYL B
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:B
Last Name:WEVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S ROSELLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2973
Mailing Address - Country:US
Mailing Address - Phone:630-773-2478
Mailing Address - Fax:
Practice Address - Street 1:2608 GOVERNMENT CENTER DR
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8302
Practice Address - Country:US
Practice Address - Phone:231-398-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPHYSICIAN213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery