Provider Demographics
NPI:1952596462
Name:WEILER, AMY S (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:WEILER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-784-7000
Mailing Address - Fax:773-784-7190
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-784-7000
Practice Address - Fax:773-784-7190
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2010-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036117858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117858OtherSTATE LICENSE