Provider Demographics
NPI:1508821539
Name:WEBER, NORMAN A (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6329
Mailing Address - Fax:616-453-1725
Practice Address - Street 1:1676 VIEWPOND DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4994
Practice Address - Country:US
Practice Address - Phone:616-281-7111
Practice Address - Fax:616-281-5156
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA74977Medicare UPIN
MI54100466082Medicare ID - Type Unspecified
5410046Medicare PIN