Healthcare Provider Details

I. General information

NPI: 1609898915
Provider Name (Legal Business Name): DENNIS EDWARD WEILAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11779 N 114TH WAY
SCOTTSDALE AZ
85259-2607
US

IV. Provider business mailing address

11779 N 114TH WAY
SCOTTSDALE AZ
85259-2607
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-6652
  • Fax:
Mailing address:
  • Phone: 480-767-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4749
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: