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General NPI Number Information
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NPI Number | 1992420822
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Entity Type | Individual
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Provider Name | MICHAEL T WEISS NP
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Gender | Male
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 4927 N WASHTENAW AVE
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City | CHICAGO
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State | IL
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Zip | 60625-7091
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Country | US
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Telephone | 630-835-8443
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Fax |
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Provider Business Mailing Address
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Address Line | 50 S B B KING BLVD STE 100
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City | MEMPHIS
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State | TN
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Zip | 38103-9802
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Country | US
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Telephone | 901-436-1381
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022057127
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License Number State | IL
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