Provider Demographics
NPI:1285670646
Name:MICHAEL L WEISS MD LTD
Entity Type:Organization
Organization Name:MICHAEL L WEISS MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-9339
Mailing Address - Street 1:4626 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2247
Mailing Address - Country:US
Mailing Address - Phone:614-538-9339
Mailing Address - Fax:614-538-9162
Practice Address - Street 1:4626 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2247
Practice Address - Country:US
Practice Address - Phone:614-538-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG4776OtherMEDICARE RAILROAD
OH2134845Medicaid
OH2134845Medicaid