Provider Demographics
NPI:1699869842
Name:WEITZEL, MELISSA GAIL (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4420 N KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4223
Mailing Address - Country:US
Mailing Address - Phone:312-908-8342
Mailing Address - Fax:312-503-0662
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 18-250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-908-6888
Practice Address - Fax:312-503-0662
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical