Provider Demographics
NPI:1376507137
Name:WEIGEL, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6600
Mailing Address - Country:US
Mailing Address - Phone:312-951-5800
Mailing Address - Fax:312-951-5816
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6600
Practice Address - Country:US
Practice Address - Phone:312-951-5800
Practice Address - Fax:312-951-5816
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0722282080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072228Medicaid
IL036072228Medicaid
IL363978402OtherTIN
ILE46230Medicare UPIN