MEDICARE: MITCHELL P. WEIKERT 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	207W00000X	Ophthalmology Physician	L6713	TX

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	4259873	OTHER	TX	BLUE LINK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8J3913	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1932198397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL P. WEIKERT M.D.

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-798-6100
Fax Number	:	713-798-4231

Provider Business Practice Location Address
First Line	:	1977 BUTLER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4101
Country	:	US
Telephone Number	:	713-798-6100
Fax Number	:	713-798-4231

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	12/04/2020

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