MEDICARE: ROBERT D. WEAVER DPM INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36002892	OH

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	:	1790804656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D. WEAVER DPM INC

Provider Business Mailing Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE #104
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-442-3113
Fax Number	:	440-442-5137

Provider Business Practice Location Address
First Line	:	6551 WILSON MILLS RD
Second Line	:	SUITE #104
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-3495
Country	:	US
Telephone Number	:	440-442-3113
Fax Number	:	440-442-5137

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT D WEAVER
Credential	:	DPM
Telephone Number	:	440-442-3113

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/01/2010

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