Healthcare Provider Details

I. General information

NPI: 1265573281
Provider Name (Legal Business Name): LOWELL M. WEINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 COUNTRY CLUB RD
ANN ARBOR MI
48105-1038
US

IV. Provider business mailing address

1155 COUNTRY CLUB RD
ANN ARBOR MI
48105-1038
US

V. Phone/Fax

Practice location:
  • Phone: 734-645-1254
  • Fax:
Mailing address:
  • Phone: 734-645-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301029298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: