Healthcare Provider Details

I. General information

NPI: 1376596726
Provider Name (Legal Business Name): MICHAEL D WEISS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/24/2008
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 Code207VG0400X
TaxonomyGynecology Physician
License Number5101007574
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: