Provider Demographics
NPI:1356501894
Name:WEINER, JUSTIN I (DO)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:I
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:12251 S 80TH AVE STE 1780
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1290
Mailing Address - Country:US
Mailing Address - Phone:708-923-3420
Mailing Address - Fax:708-923-3399
Practice Address - Street 1:12251 S 80TH AVE STE 1780
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1290
Practice Address - Country:US
Practice Address - Phone:708-923-3420
Practice Address - Fax:708-923-3399
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036165018207RC0200X, 207RP1001X
NY256725207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine