Provider Demographics
NPI:1659354058
Name:WEISS, MICHAEL D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-4769
Mailing Address - Fax:888-824-2176
Practice Address - Street 1:1020 N MASON RD
Practice Address - Street 2:DIV SURG ACCS PODIATRY, STE 225
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6666
Practice Address - Country:US
Practice Address - Phone:314-747-4769
Practice Address - Fax:888-824-2176
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO301750006Medicaid
MO1659354058Medicaid