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Individual

GLEN A WEISGERBER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 S 5TH ST, AUBURN, IL 62615-1402
(217) 438-6175
(217) 438-6550
Mailing address
100 S 5TH ST, PO BOX 227, AUBURN, IL 62614-1402
(217) 438-6175
(217) 438-6550

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036061310
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036061310
IL
01
14D0435318
CLIA
IL
Enumeration date
03/10/2006
Last updated
06/14/2010
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