MEDICARE: MAIZIE WEIRICH

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861262529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIZIE WEIRICH

Provider Business Mailing Address
First Line	:	5650 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 W CENTRAL AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1519
Country	:	US
Telephone Number	:	419-378-7076
Fax Number	:

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/05/2024

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