Provider Demographics
NPI:1326075268
Name:WEISS, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WEISS
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 1:9725 3RD AVE NE STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2024
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE 208
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-885-0261
Practice Address - Fax:425-883-8474
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026313207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1076314Medicaid
WA030004550OtherRAIL ROAD MEDICARE
WA6489WEWOtherREGENCE
WA6489WEWOtherREGENCE