Individual
MERVYN J. WEIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4640 N MARINE DR, SUITE 6100C, CHICAGO, IL 60640-5719
(773) 769-4411
(773) 769-5140
Mailing address
4640 N MARINE DR, SUITE 6100C, CHICAGO, IL 60640-5719
(773) 769-4411
(773) 769-5140
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
IL
207RG0100X
Gastroenterology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01615327
BLUE CROSS
IL
01
—
36040513
IL LICENSE NUMBER
IL
Enumeration date
08/11/2005
Last updated
09/11/2025
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