Provider Demographics
NPI:1578822318
Name:WEINER, JOEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:WEINER
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 1:720 E WISCONSIN AVE
Mailing Address - Street 2:2W440
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4703
Mailing Address - Country:US
Mailing Address - Phone:414-661-3952
Mailing Address - Fax:414-661-3915
Practice Address - Street 1:720 E WISCONSIN AVE
Practice Address - Street 2:2W440
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4703
Practice Address - Country:US
Practice Address - Phone:414-661-3952
Practice Address - Fax:414-661-3915
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40724-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine