Individual
JUDITH K WEIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
739 N JEFFERSON ST, SUITE 200, MASCOUTAH, IL 62258-1447
(618) 566-8810
(618) 566-7121
Mailing address
739 N JEFFERSON ST, SUITE 200, MASCOUTAH, IL 62258-1447
(618) 566-8810
(618) 566-7121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036089439
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089439
—
IL
Enumeration date
05/16/2006
Last updated
12/17/2009
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