Provider Demographics
NPI:1467627687
Name:MICHAEL D. WEISS, D.O., P.C.
Entity Type:Organization
Organization Name:MICHAEL D. WEISS, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-608-2737
Mailing Address - Street 1:930 W AVON RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2759
Mailing Address - Country:US
Mailing Address - Phone:248-608-2737
Mailing Address - Fax:
Practice Address - Street 1:930 W AVON RD
Practice Address - Street 2:SUITE 18
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2759
Practice Address - Country:US
Practice Address - Phone:248-608-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF07224Medicare UPIN