Provider Demographics
NPI:1548268121
Name:WEINBERG, STEPHEN A (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E GOLF RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1250
Mailing Address - Country:US
Mailing Address - Phone:847-390-7666
Mailing Address - Fax:847-390-9345
Practice Address - Street 1:1455 E GOLF RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1250
Practice Address - Country:US
Practice Address - Phone:847-390-7666
Practice Address - Fax:847-390-9345
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002671213E00000X
IL016002671213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60000380OtherBCBS
IL016002671Medicaid
IL60000380OtherBCBS
IL016002671Medicaid