Healthcare Provider Details

I. General information

NPI: 1417122573
Provider Name (Legal Business Name): MARC WEITZMAN,DPM PC
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

1010 N CAMPBELL RD 2
ROYAL OAK MI
48067-1570
US

IV. Provider business mailing address

1010 N CAMPBELL RD 2
ROYAL OAK MI
48067-1570
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-1020
  • Fax: 248-547-7066
Mailing address:
  • Phone: 248-547-1020
  • Fax: 248-547-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number000907
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000907
License Number StateMI

VIII. Authorized Official

Name: DR. MARC WEITZMAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 248-547-1020