Provider Demographics
NPI:1427253483
Name:REUBEN R. WEISZ, M.D., P.C.
Entity type:Organization
Organization Name:REUBEN R. WEISZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-625-2600
Mailing Address - Street 1:1 S GREENLEAF ST
Mailing Address - Street 2:SUITE 'L'
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-625-2600
Mailing Address - Fax:847-625-2602
Practice Address - Street 1:1 S GREENLEAF ST
Practice Address - Street 2:SUITE 'L'
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-625-2600
Practice Address - Fax:847-625-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360611132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061113Medicaid
ILC39564Medicare UPIN
IL211077Medicare ID - Type UnspecifiedMEDICARE