Provider Demographics
NPI:1114019585
Name:WEIZER, ALON ZADOK (MD)
Entity Type:Individual
Prefix:
First Name:ALON
Middle Name:ZADOK
Last Name:WEIZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:4302 ALTON RD STE 540
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2842
Practice Address - Country:US
Practice Address - Phone:056-742-4993
Practice Address - Fax:305-674-2899
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084795208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4766260Medicaid
MII41088Medicare UPIN
MI0H16030069Medicare ID - Type Unspecified