Provider Demographics
NPI:1225032279
Name:WEISBERG, HERSHEL ZIS (MD)
Entity Type:Individual
Prefix:
First Name:HERSHEL
Middle Name:ZIS
Last Name:WEISBERG
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 1:551 HOSPITAL ROAD
Mailing Address - Street 2:NEW RICHMOND CLINIC
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017
Mailing Address - Country:US
Mailing Address - Phone:715-243-3400
Mailing Address - Fax:715-243-3415
Practice Address - Street 1:551 HOSPITAL ROAD
Practice Address - Street 2:NEW RICHMOND CLINIC
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017
Practice Address - Country:US
Practice Address - Phone:715-243-3400
Practice Address - Fax:715-243-3415
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7118207V00000X
MN49465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34772800Medicaid
MN33640100Medicaid
TX046837301Medicaid
MN160002695Medicare PIN
MNG94514Medicare UPIN