Provider Demographics
NPI:1619918281
Name:WEIMER, CHANDRA R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:R
Last Name:WEIMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:R
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6208
Practice Address - Street 1:2909 E GRAND RIVER AVE STE 302
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4335
Practice Address - Country:US
Practice Address - Phone:517-337-8680
Practice Address - Fax:517-364-8681
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine