Healthcare Provider Details

I. General information

NPI: 1841826898
Provider Name (Legal Business Name): GREG J WEIDMAN BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

596 N PORT CRESCENT ST
BAD AXE MI
48413-1209
US

IV. Provider business mailing address

3021 WILDWOOD DR
SAGINAW MI
48603-1638
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-6966
  • Fax:
Mailing address:
  • Phone: 989-245-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501002373
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: