Healthcare Provider Details

I. General information

NPI: 1689766826
Provider Name (Legal Business Name): MICHAEL D. WEISS, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W OAKLAND PARK BLVD
LAUDERDALE LAKES FL
33313-1503
US

IV. Provider business mailing address

1130 TEN ROD RD D201
NORTH KINGSTOWN RI
02852-4161
US

V. Phone/Fax

Practice location:
  • Phone: 954-735-6000
  • Fax: 954-677-2614
Mailing address:
  • Phone: 401-295-8655
  • Fax: 401-295-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME62895
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL D WEISS
Title or Position: INTERVENTIONAL RADIOLOGIST
Credential: MD
Phone: 401-295-8655