Healthcare Provider Details

I. General information

NPI: 1801322268
Provider Name (Legal Business Name): MICHAEL WEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S DORA ST
UKIAH CA
95482-8325
US

IV. Provider business mailing address

1165 S DORA ST
UKIAH CA
95482-8325
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3636
  • Fax: 707-463-2714
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG40152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG40152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: