Healthcare Provider Details

I. General information

NPI: 1336218650
Provider Name (Legal Business Name): MICHAEL BARRY WEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 20TH ST SUITE 140
VERO BEACH FL
32960-2427
US

IV. Provider business mailing address

3375 20TH ST SUITE 140
VERO BEACH FL
32960-2427
US

V. Phone/Fax

Practice location:
  • Phone: 772-299-7299
  • Fax:
Mailing address:
  • Phone: 772-299-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME0066191
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0066191
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberME0066191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: