Provider Demographics
NPI:1598900748
Name:WEIMAN, MARK M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:WEIMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE STE 809
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3776
Mailing Address - Country:US
Mailing Address - Phone:312-372-3377
Mailing Address - Fax:312-372-5663
Practice Address - Street 1:30 N MICHIGAN AVE STE 809
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3776
Practice Address - Country:US
Practice Address - Phone:312-372-3377
Practice Address - Fax:312-372-5663
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0163381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice