Provider Demographics
NPI:1710239439
Name:DANIEL WEISSBLUTH, M.D, S.C
Entity Type:Organization
Organization Name:DANIEL WEISSBLUTH, M.D, S.C
Other - Org Name:WEISSBLUTH PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISSBLUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-202-0300
Mailing Address - Street 1:737 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2615
Mailing Address - Country:US
Mailing Address - Phone:312-202-0300
Mailing Address - Fax:312-202-0383
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-202-0300
Practice Address - Fax:312-202-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122082208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty