Provider Demographics
NPI:1437295144
Name:WEINER, GLENN I (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:I
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 4003
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-364-0800
Mailing Address - Fax:847-364-0854
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:SUITE 4003
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3668
Practice Address - Country:US
Practice Address - Phone:847-364-0800
Practice Address - Fax:847-364-0854
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036053094207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21608486OtherBLUE CROSS BLUE SHIELD
IL036053094Medicaid
D13967Medicare UPIN
IL036053094Medicaid