Provider Demographics
NPI:1932149945
Name:WEISS, SHANA ESTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:ESTHER
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1900 HOLLISTER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5227
Mailing Address - Country:US
Mailing Address - Phone:847-573-9663
Mailing Address - Fax:847-573-9662
Practice Address - Street 1:1900 HOLLISTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5227
Practice Address - Country:US
Practice Address - Phone:847-573-9663
Practice Address - Fax:847-573-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036101407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine