Healthcare Provider Details

I. General information

NPI: 1467627687
Provider Name (Legal Business Name): MICHAEL D. WEISS, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 W AVON RD SUITE 18
ROCHESTER HILLS MI
48307-2759
US

IV. Provider business mailing address

930 W AVON RD SUITE 18
ROCHESTER HILLS MI
48307-2759
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-2737
  • Fax:
Mailing address:
  • Phone: 248-608-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101007574
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL D WEISS
Title or Position: OWNER
Credential: D.O.
Phone: 248-608-2737