Provider Demographics
NPI:1720132210
Name:JWEIED, EIAS E (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EIAS
Middle Name:E
Last Name:JWEIED
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:4400 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:083-463-2877
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI56018-20208G00000X
IN01067276A208G00000X
IL036-100901208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720132210Medicaid
IN200992020DMedicaid
IN200992020BMedicaid
IN200992020EMedicaid
IL036100901Medicaid
IN200992020CMedicaid
IN200992020AMedicaid
ILP00817184Medicare PIN
IL211578005Medicare PIN
IL036100901Medicaid
IN200992020DMedicaid
IN200992020BMedicaid
IN200992020EMedicaid