Provider Demographics
NPI:1174633218
Name:WEISER, SIDNEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
Last Name:WEISER
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 1:724 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3007
Mailing Address - Country:US
Mailing Address - Phone:312-225-2444
Mailing Address - Fax:312-225-9366
Practice Address - Street 1:724 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3007
Practice Address - Country:US
Practice Address - Phone:312-225-2444
Practice Address - Fax:312-225-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004192Medicaid
IL016004192Medicaid
IL211351Medicare ID - Type Unspecified