Provider Demographics
NPI:1609076348
Name:SAMUEL WEISS, MD,SC
Entity Type:Organization
Organization Name:SAMUEL WEISS, MD,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-527-4541
Mailing Address - Street 1:500 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1520
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3777
Mailing Address - Country:US
Mailing Address - Phone:312-527-4541
Mailing Address - Fax:847-329-9613
Practice Address - Street 1:500 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1520
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3777
Practice Address - Country:US
Practice Address - Phone:312-527-4541
Practice Address - Fax:847-329-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.002341305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL76255Medicare PIN
ILG80576Medicare UPIN