Provider Demographics
NPI:1992814628
Name:WEISKOPF, JEROME S (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:S
Last Name:WEISKOPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6533 LEXUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-3015
Mailing Address - Country:US
Mailing Address - Phone:815-397-4180
Mailing Address - Fax:815-397-1250
Practice Address - Street 1:6533 LEXUS DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3015
Practice Address - Country:US
Practice Address - Phone:815-397-4180
Practice Address - Fax:815-397-1250
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036528932086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI362958896015OtherBLUE CROSS OF WI
131087000OtherUS DEPT OF LABOR
IL101-00485OtherBLUE CROSS IF IL
IL036052893Medicaid
WI31303800OtherWI PUBLIC AID
791240158OtherRAILROAD MEDICARE
131087000OtherUS DEPT OF LABOR
WI31303800OtherWI PUBLIC AID