Provider Demographics
NPI:1043240559
Name:WEISS, HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-356-8610
Mailing Address - Fax:248-356-6473
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 606
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-356-8610
Practice Address - Fax:248-356-6473
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010 36735207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1439727Medicaid
MI163 2381Medicare ID - Type UnspecifiedMEDICARE NUMBER
MIB44793Medicare UPIN