Provider Demographics
NPI:1609834019
Name:WEISS, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
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 1:1141 SPRINGBORROW DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2141
Mailing Address - Country:US
Mailing Address - Phone:810-230-8353
Mailing Address - Fax:
Practice Address - Street 1:G3239 BEECHER RD
Practice Address - Street 2:SUITE F
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3616
Practice Address - Country:US
Practice Address - Phone:810-733-6780
Practice Address - Fax:810-733-6939
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010506002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1020941OtherMCLAREN HEALTH PLAN
MI1020941OtherMHP FENTON
MI0990536OtherHEALTH PLUS
MA4020942OtherMCLAREN
MI4822485100Medicaid
MI4891811Medicaid
MI4891787Medicaid
MI1608119OtherFIRST HEALTH
MI230141OtherHAP/HEALTH ALLIANCE PLAN
MI4822449100Medicaid
MI4822494100Medicaid
MIRA820073OtherMCARE
MA4020942OtherMCLAREN
MI230141OtherHAP/HEALTH ALLIANCE PLAN
MI0990536OtherHEALTH PLUS
MI1020941OtherMCLAREN HEALTH PLAN