Healthcare Provider Details

I. General information

NPI: 1497743694
Provider Name (Legal Business Name): MICHAEL M WEINIK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3646
  • Fax: 215-707-6594
Mailing address:
  • Phone: 215-707-3646
  • Fax: 215-707-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0S006020L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: