Provider Demographics
NPI:1114265352
Name:WEISS, KAREN JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JANE
Last Name:WEISS
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 1:1300 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 11C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2169
Mailing Address - Country:US
Mailing Address - Phone:312-622-6632
Mailing Address - Fax:
Practice Address - Street 1:1300 N LAKE SHORE DR
Practice Address - Street 2:SUITE 11C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2169
Practice Address - Country:US
Practice Address - Phone:312-622-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360798962085R0202X
CAG709952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology