Provider Demographics
NPI:1568634293
Name:WEINER, MICHELLE ERIN (DO, MPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ERIN
Last Name:WEINER
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N OCEAN DR STE I
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-3813
Mailing Address - Country:US
Mailing Address - Phone:954-919-7706
Mailing Address - Fax:954-919-7712
Practice Address - Street 1:3501 N OCEAN DR STE I
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-3813
Practice Address - Country:US
Practice Address - Phone:954-919-7706
Practice Address - Fax:954-919-7712
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10906208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10906OtherLICENSE