Healthcare Provider Details

I. General information

NPI: 1659354058
Provider Name (Legal Business Name): MICHAEL D WEISS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N MASON RD DIV SURG ACCS PODIATRY, STE 225
SAINT LOUIS MO
63141-6666
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-4769
  • Fax: 888-824-2176
Mailing address:
  • Phone: 314-747-4769
  • Fax: 888-824-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000467
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: