MEDICARE: JERROLD H WEINBERG M.D.

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	207V00000X	Obstetrics & Gynecology Physician	20351071251	MI

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

General Provider Information

NPI Number	:	1639104540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERROLD H WEINBERG M.D.

Provider Business Mailing Address
First Line	:	5053 PHEASANT CV
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2082
Country	:	US
Telephone Number	:	248-884-4071
Fax Number	:

Provider Business Practice Location Address
First Line	:	5053 PHEASANT CV
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2082
Country	:	US
Telephone Number	:	248-884-4071
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/22/2020

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