Provider Demographics
NPI:1538515473
Name:WEINBERG, SAMUEL E
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N FAIRBANKS CT STE 2-458
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3013
Mailing Address - Country:US
Mailing Address - Phone:312-926-3211
Mailing Address - Fax:312-503-8259
Practice Address - Street 1:710 N FAIRBANKS CT STE 2-458
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3013
Practice Address - Country:US
Practice Address - Phone:312-926-3211
Practice Address - Fax:312-503-8259
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125075240207ZP0105X
IL036160912207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine