Provider Demographics
NPI:1861434805
Name:WEINZWEIG, JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:WEINZWEIG
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 1:845 NORTH MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 980W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2218
Mailing Address - Country:US
Mailing Address - Phone:312-642-0400
Mailing Address - Fax:312-642-0500
Practice Address - Street 1:845 NORTH MICHIGAN AVENUE
Practice Address - Street 2:SUITE 980W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2218
Practice Address - Country:US
Practice Address - Phone:312-642-0400
Practice Address - Fax:312-642-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123979208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0131750Medicaid
MA0131750Medicaid