Healthcare Provider Details

I. General information

NPI: 1366372187
Provider Name (Legal Business Name): MICHAEL ZOESCH WEAVER CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BAKER ST APT 31
NORWALK OH
44857-1372
US

IV. Provider business mailing address

57 BAKER ST APT 31
NORWALK OH
44857-1372
US

V. Phone/Fax

Practice location:
  • Phone: 419-239-4586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.007207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: