Provider Demographics
NPI:1568445955
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 1:4790 BARKLEY CIR
Mailing Address - Street 2:BLDG A
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-939-1330
Practice Address - Street 1:4790 BARKLEY CIR
Practice Address - Street 2:BLDG A
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-939-1330
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055049207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5128504OtherAETNA
FL2400973OtherGHI
FL251891100Medicaid
FL110113857OtherRAILROAD MEDICARE
FL1331050OtherUNITED HEALTHCARE
FL1888701OtherCIGNA
FL248308OtherAVMED
FL1568445955OtherTRICARE
FL27600OtherBCBS
FL27600ZMedicare ID - Type Unspecified
FL1568445955OtherTRICARE