Provider Demographics
NPI:1689665739
Name:WEIERMILLER, RICHARD C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:WEIERMILLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1055 SOUTH BLVD E
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5465
Mailing Address - Country:US
Mailing Address - Phone:248-817-2230
Mailing Address - Fax:248-817-2891
Practice Address - Street 1:1055 SOUTH BLVD E
Practice Address - Street 2:STE 220
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5465
Practice Address - Country:US
Practice Address - Phone:248-817-2230
Practice Address - Fax:248-817-2891
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI348226Medicaid
G80793Medicare UPIN
MI348226Medicaid