Provider Demographics
NPI:1356443600
Name:WEISMAN, MARC F (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:F
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-543-0600
Mailing Address - Fax:248-543-4720
Practice Address - Street 1:1200 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-543-0600
Practice Address - Fax:248-543-4720
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49499Medicare UPIN
0F363964081Medicare ID - Type Unspecified