Basic Information
| Provider Information | |||||||||
| NPI: | 1144661448 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRYWEATHER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 SPRING RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728800 | ||||||||
| FaxNumber: | 6304729502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601604039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089387209 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085.004697 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.