Healthcare Provider Details

I. General information

NPI: 1760448682
Provider Name (Legal Business Name): STUART B. WEINER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 S STATE RD
GOODRICH MI
48438-9770
US

IV. Provider business mailing address

7280 S STATE RD
GOODRICH MI
48438-9770
US

V. Phone/Fax

Practice location:
  • Phone: 810-636-5000
  • Fax: 810-636-5019
Mailing address:
  • Phone: 810-636-5000
  • Fax: 810-636-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5101009926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: