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NPI Code Detail

MEDICARE: DR. IAN ALLAN WEISSMAN D.O.

MEDICARE: DR. IAN ALLAN WEISSMAN 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
12085R0202XDiagnostic Radiology Physician47301WI

Other Identifiers

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

General Provider Information

NPI Number : 1659339240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IAN ALLAN WEISSMAN D.O.
Provider Business Mailing Address
First Line : 1660 N PROSPECT AVE
Second Line : #2207
City : MILWAUKEE
State : WI
Zip : 53202-2400
Country : US
Telephone Number : 414-289-7662
Fax Number :
Provider Business Practice Location Address
First Line : 2925 W OKLAHOMA AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-4329
Country : US
Telephone Number : 414-649-6430
Fax Number : 414-649-5563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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