Provider Demographics
NPI:1689670366
Name:WEISZ, REUBEN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:ROBERT
Last Name:WEISZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 S GREENLEAF ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-625-2600
Mailing Address - Fax:847-625-2602
Practice Address - Street 1:1 S GREENLEAF ST
Practice Address - Street 2:STE L
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-625-2600
Practice Address - Fax:847-625-2602
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360611132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061113Medicaid
ILC39564Medicare UPIN
211077Medicare PIN