Provider Demographics
NPI:1891743001
Name:DR CAROL R WEINBERG MD SC
Entity Type:Organization
Organization Name:DR CAROL R WEINBERG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-717-1771
Mailing Address - Street 1:608 S WASHINGTON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6657
Mailing Address - Country:US
Mailing Address - Phone:630-717-1771
Mailing Address - Fax:630-717-0091
Practice Address - Street 1:608 S WASHINGTON ST
Practice Address - Street 2:STE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6657
Practice Address - Country:US
Practice Address - Phone:630-717-1771
Practice Address - Fax:630-717-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36072940Medicaid
IL36072940Medicaid
E24614Medicare UPIN