Healthcare Provider Details

I. General information

NPI: 1821190497
Provider Name (Legal Business Name): ALAN P WEAMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 DAVISON RD
DAVISON MI
48423-2029
US

IV. Provider business mailing address

3495 S CENTER RD
BURTON MI
48519-1455
US

V. Phone/Fax

Practice location:
  • Phone: 810-653-4145
  • Fax: 810-653-1741
Mailing address:
  • Phone: 810-424-2007
  • Fax: 810-743-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301035257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: