Healthcare Provider Details

I. General information

NPI: 1851893861
Provider Name (Legal Business Name): MR. MICHAEL DOUGLAS WEBER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W LONG ST
COLUMBUS OH
43215-2817
US

IV. Provider business mailing address

72 HAMILTON PARK APT C3
COLUMBUS OH
43203-1832
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-1131
  • Fax:
Mailing address:
  • Phone: 440-915-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: