Provider Demographics
NPI:1043316219
Name:WEISMAN, MICHAEL IRA (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IRA
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD STE 3100
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:866-940-9890
Practice Address - Street 1:2180 PFINGSTEN RD STE 3100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1339
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:866-940-9890
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003033213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36974Medicare UPIN