MEDICARE: DR. MICHAEL S WEISHAUS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002387	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0F37720	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MW002387	OTHER	MI	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275511867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S WEISHAUS O.D.

Provider Business Mailing Address
First Line	:	6523 TELEGRAPH RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3066
Country	:	US
Telephone Number	:	248-593-9955
Fax Number	:	248-593-9966

Provider Business Practice Location Address
First Line	:	6523 TELEGRAPH RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3066
Country	:	US
Telephone Number	:	248-593-9955
Fax Number	:	248-593-9966

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	05/16/2016

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