Provider Demographics
NPI:1275640237
Name:WEBER, ERIC FRANK (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:FRANK
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:1061 E COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086
Practice Address - Country:US
Practice Address - Phone:262-644-2900
Practice Address - Fax:262-670-7112
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30171700Medicaid
WIP00941518OtherRR MEDICARE
WI670050039Medicare PIN
WIP00941518OtherRR MEDICARE
WI019940626Medicare PIN
WI462364852Medicare PIN