Provider Demographics
NPI:1063444784
Name:WEISMANTEL, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:WEISMANTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 245 C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1800
Mailing Address - Country:US
Mailing Address - Phone:517-364-5710
Mailing Address - Fax:517-364-5718
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 245 C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5710
Practice Address - Fax:517-364-5718
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4128177Medicaid
MI4128177Medicaid
MI0C36088039Medicare PIN