Provider Demographics
NPI:1043305683
Name:WEISS, BRIAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:H
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 80TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7184
Mailing Address - Country:US
Mailing Address - Phone:219-791-9785
Mailing Address - Fax:219-791-9787
Practice Address - Street 1:300 WEST 80TH AVE.
Practice Address - Street 2:STE A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6258
Practice Address - Country:US
Practice Address - Phone:219-791-9785
Practice Address - Fax:219-791-9787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080144835OtherRAILROAD MEDICARE
IN200000310Medicaid
IN703080Medicare ID - Type Unspecified
IN200000310Medicaid