Provider Demographics
NPI:1417999574
Name:WEISMAN, IRWIN D (MD)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:D
Last Name:WEISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN236812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300123865OtherRAILROAD MEDICARE MN
WI30706600Medicaid
MN52F86WEOtherBLUE CROSS
MN280877300Medicaid
MN596687OtherAMERICA'S PPO
WIP00287185OtherRAILROAD MEDICARE WI
IA1931915Medicaid
MN1018007OtherPREFERRED ONE
MN1601435OtherMEDICA
MN105662OtherUCARE
MN300G2WEOtherBLUE CROSS
MNHP33430OtherHEALTHPARTNERS
IA1931915Medicaid
MN300003004Medicare PIN
WIP00287185OtherRAILROAD MEDICARE WI
MNHP33430OtherHEALTHPARTNERS
MN105662OtherUCARE