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General NPI Number Information
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NPI Number | 1457385841
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Entity Type | Organization
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Legal Business Name | LARRY WEISS DPM PC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 17421 GREENFIELD
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City | DETROIT
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State | MI
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Zip | 48235
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Country | US
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Telephone | 313-273-7091
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Fax | 313-273-7694
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Provider Business Mailing Address
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Address Line | 17421 GREENFIELD
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City | DETROIT
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State | MI
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Zip | 48235
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Country | US
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Telephone | 313-273-7091
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Fax | 313-273-7694
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Authorized Official
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Title or Position | BILLING AGENT
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Name | DEBRA HILLSON
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Credential |
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Telephone | 248-569-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901000807
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License Number State | MI
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