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General NPI Number Information
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NPI Number | 1841826898
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Entity Type | Individual
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Provider Name | GREG J WEIDMAN BC-HIS
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 596 N PORT CRESCENT ST
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City | BAD AXE
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State | MI
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Zip | 48413-1209
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Country | US
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Telephone | 989-269-6966
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 WILDWOOD DR
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City | SAGINAW
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State | MI
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Zip | 48603-1638
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Country | US
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Telephone | 989-245-8828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3501002373
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License Number State | MI
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