Organization
HYDE PARK ASSOCIATES IN MEDICINE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WEAVER M.D. (PHYSICIAN MANAGER)
(773) 493-8212
Entity
Organization
Contact information
Practice address
1515 E 52ND PL, 3RD FLOOR, CHICAGO, IL 60615-4390
(773) 493-8212
(773) 955-2166
Mailing address
1515 E 52ND PL, 3RD FLOOR, CHICAGO, IL 60615-4390
(773) 493-8212
(773) 955-2166
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001616367
BLUE CROSS BLUE SHIELD
IL
01
—
0005485045
AETNA
—
01
—
CF1260
RR MEDICARE
—
Enumeration date
08/20/2006
Last updated
08/22/2020
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