Healthcare Provider Details

I. General information

NPI: 1114019585
Provider Name (Legal Business Name): ALON ZADOK WEIZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 540
MIAMI BEACH FL
33140-2842
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 56-742-4993
  • Fax: 305-674-2899
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301084795
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: