Basic Information
| Provider Information | |||||||||
| NPI: | 1245526680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | WEILI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 E GRANT ST | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | MACOMB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614553368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098334101 | ||||||||
| FaxNumber: | 3098361547 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 E GRANT ST | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | MACOMB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614553368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098334101 | ||||||||
| FaxNumber: | 3098361547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PG154577 | OR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036135529 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036135529 | 05 | IL | MEDICAID |