MEDICARE: JOEL MARC WEINBERGER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS 4999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568411577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL MARC WEINBERGER D.O.

Provider Business Mailing Address
First Line	:	720 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4100
Country	:	US
Telephone Number	:	407-933-2522
Fax Number	:	407-932-0215

Provider Business Practice Location Address
First Line	:	720 OAK COMMONS BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4100
Country	:	US
Telephone Number	:	407-933-2522
Fax Number	:	407-932-0215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/01/2019

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