Provider Demographics
NPI:1851330476
Name:WEISS-COLEMAN, REBECCA LEA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEA
Last Name:WEISS-COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:150 E HURON ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2948
Mailing Address - Country:US
Mailing Address - Phone:312-926-3627
Mailing Address - Fax:312-926-6285
Practice Address - Street 1:6810 N MCCORMICK BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2709
Practice Address - Country:US
Practice Address - Phone:847-674-6900
Practice Address - Fax:847-329-4728
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108337207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98030Medicare UPIN