Provider Demographics
NPI:1912928557
Name:WEINER, PATRICE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:ANN
Last Name:WEINER
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 1:800 BIESTERFIELD RD STE 510
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3367
Mailing Address - Country:US
Mailing Address - Phone:847-981-3660
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD STE 510
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3367
Practice Address - Country:US
Practice Address - Phone:847-981-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036141359207RC0200X, 207RP1001X
CAG65159207RP1001X, 207RC0200X
HIMD-14373207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE73105Medicare UPIN
CACB266484Medicare PIN