Provider Demographics
NPI:1114099835
Name:HAROLD WEISS MD&MARK HAIMANN MD&JOEL MILLER MD&SUSAN MALINOWSKI MD
Entity Type:Organization
Organization Name:HAROLD WEISS MD&MARK HAIMANN MD&JOEL MILLER MD&SUSAN MALINOWSKI MD
Other - Org Name:RETINA CONSULTANTS OF MICHIGAN, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-356-5034
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:248-356-6406
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:248-356-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2598450Medicaid
MI4549310Medicaid
MI1439727Medicaid
MI1532688Medicaid
MI4151694Medicaid
MI1532688Medicaid
MI1439727Medicaid
MI2598450Medicaid
MIB44754Medicare UPIN
MIF30141Medicare UPIN
MI4151694Medicaid
MI4549310Medicaid
MIH46606Medicare UPIN
MI0M89510Medicare ID - Type UnspecifiedSUSAN MALINOWSKI MD
MIB44793Medicare UPIN