Provider Demographics
NPI:1619134996
Name:WEILER, COLLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:WEILER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:WEILER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:331-221-2357
Practice Address - Street 1:1100 LAKE ST STE 230
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1095
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-2759
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine