Provider Demographics
NPI:1508816901
Name:WEINER, LAWRENCE K (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:K
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:18
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-663-9700
Mailing Address - Fax:847-663-9702
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:18
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-663-9700
Practice Address - Fax:847-663-9702
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036069107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069107Medicaid
IL596750Medicare ID - Type Unspecified
IL036069107Medicaid