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General NPI Number Information
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NPI Number | 1639360878
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Entity Type | Organization
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Legal Business Name | D MICHAEL WEILL DPM - A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 419 1/2 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 323-462-1491
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Fax | 323-285-5447
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Provider Business Mailing Address
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Address Line | 419 1/2 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 323-462-1491
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Fax | 323-285-5447
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Authorized Official
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Title or Position | PRESIDENT/OFFICER
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Name | DR. D. MICHAEL WEILL
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Credential | D.P.M.
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Telephone | 323-462-1491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E2275
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License Number State | CA
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