Provider Demographics
NPI:1043362189
Name:WEIL, ROBERT A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WEIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 TRADE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-898-3505
Mailing Address - Fax:630-898-9378
Practice Address - Street 1:95 TRADE ST
Practice Address - Street 2:STE 102
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-898-3505
Practice Address - Fax:630-898-9378
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002670213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
60000761OtherBCBS PROVIDER
60000761OtherBCBS PROVIDER
T35490Medicare UPIN
236580Medicare ID - Type Unspecified