Provider Demographics
NPI:1154093839
Name:WEINKLE DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:WEINKLE DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HOLLOWAY
Authorized Official - Last Name:WEINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-794-5432
Mailing Address - Street 1:5601 21ST AVE W STE B
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5642
Mailing Address - Country:US
Mailing Address - Phone:941-794-5432
Mailing Address - Fax:941-794-5682
Practice Address - Street 1:5601 21ST AVE W STE B
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-794-5432
Practice Address - Fax:941-794-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty