Provider Demographics
NPI:1427369362
Name:WEEMS, COURTNEY (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:WEEMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3906
Mailing Address - Country:US
Mailing Address - Phone:773-644-1362
Mailing Address - Fax:773-828-4849
Practice Address - Street 1:3916 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-644-1362
Practice Address - Fax:773-828-4849
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132165208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty