Provider Demographics
NPI:1245526680
Name:ZHANG, WEILI (DO)
Entity type:Individual
Prefix:DR
First Name:WEILI
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E GRANT ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-3368
Mailing Address - Country:US
Mailing Address - Phone:309-833-4101
Mailing Address - Fax:309-836-1547
Practice Address - Street 1:515 E GRANT ST
Practice Address - Street 2:SUITE 213
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3368
Practice Address - Country:US
Practice Address - Phone:309-833-4101
Practice Address - Fax:309-836-1547
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG154577207Q00000X
IL036135529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135529Medicaid