Provider Demographics
NPI:1598010456
Name:WEISS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WEISS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOGHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSEYNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-309-4490
Mailing Address - Street 1:4600 N CLARENDON AVE
Mailing Address - Street 2:APT.1011
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5710
Mailing Address - Country:US
Mailing Address - Phone:571-309-4490
Mailing Address - Fax:
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:571-309-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.061167281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital