Provider Demographics
NPI:1639360878
Name:D MICHAEL WEILL DPM - A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:D MICHAEL WEILL DPM - A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:D. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-462-1491
Mailing Address - Street 1:419 1/2 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3013
Mailing Address - Country:US
Mailing Address - Phone:323-462-1491
Mailing Address - Fax:323-285-5447
Practice Address - Street 1:419 1/2 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3013
Practice Address - Country:US
Practice Address - Phone:323-462-1491
Practice Address - Fax:323-285-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2275213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11254Medicare UPIN