Provider Demographics
NPI:1962415992
Name:RONALD S WEISS MD SC
Entity type:Organization
Organization Name:RONALD S WEISS MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-214-0144
Mailing Address - Street 1:4401 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4250
Mailing Address - Country:US
Mailing Address - Phone:708-788-3400
Mailing Address - Fax:708-788-3472
Practice Address - Street 1:4401 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4250
Practice Address - Country:US
Practice Address - Phone:708-788-3400
Practice Address - Fax:708-788-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001608470OtherGROUP BC/BS NUMBER
IL0001608470OtherGROUP BC/BS NUMBER