Provider Demographics
NPI:1932207578
Name:WEISS, STEPHEN F (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N MULFORD RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5197
Mailing Address - Country:US
Mailing Address - Phone:815-226-9424
Mailing Address - Fax:
Practice Address - Street 1:419 N MULFORD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5197
Practice Address - Country:US
Practice Address - Phone:815-226-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery