Healthcare Provider Details

I. General information

NPI: 1417917147
Provider Name (Legal Business Name): KISA E WEEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH STREET
CANTON OH
44710
US

IV. Provider business mailing address

6046 WHIPPLE AVE NW
NORTH CANTON OH
44720
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-6333
  • Fax: 330-580-6660
Mailing address:
  • Phone: 330-433-1200
  • Fax: 330-305-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35068551B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: