Provider Demographics
NPI:1770620304
Name:FREDERICK M. WEIL, DPM
Entity type:Organization
Organization Name:FREDERICK M. WEIL, DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-310-8100
Mailing Address - Street 1:1585 N BARRINGTON RD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5020
Mailing Address - Country:US
Mailing Address - Phone:847-310-8100
Mailing Address - Fax:847-310-8156
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:SUITE 503
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1090
Practice Address - Country:US
Practice Address - Phone:847-310-8100
Practice Address - Fax:847-310-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002559213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60020661OtherBLUE CROSS BLUE SHIELD
IL567320Medicare ID - Type Unspecified