Provider Demographics
NPI:1760402796
Name:WESTON, COLLEEN S (DO)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:S
Last Name:WESTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0844
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:15474 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48170-0844
Practice Address - Country:US
Practice Address - Phone:248-615-0889
Practice Address - Fax:734-404-5317
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011723207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI35772OtherMERIDIAN MEDICAID
MI4373137-11Medicaid
MIG51808Medicare UPIN
MI35772OtherMERIDIAN MEDICAID
MI4373137-11Medicaid