Provider Demographics
NPI:1649241936
Name:WEINSTEIN, RONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15356 N HERON LN
Mailing Address - Street 2:
Mailing Address - City:BLUFORD
Mailing Address - State:IL
Mailing Address - Zip Code:62814-3603
Mailing Address - Country:US
Mailing Address - Phone:847-471-1994
Mailing Address - Fax:618-732-0094
Practice Address - Street 1:15356 N HERON LN
Practice Address - Street 2:
Practice Address - City:BLUFORD
Practice Address - State:IL
Practice Address - Zip Code:62814-3603
Practice Address - Country:US
Practice Address - Phone:847-471-1994
Practice Address - Fax:618-732-0094
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K16606Medicare ID - Type Unspecified
E24505Medicare UPIN