Provider Demographics
NPI:1710461330
Name:WEIKEL, ELIJAH GRAHAM
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:GRAHAM
Last Name:WEIKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:
Practice Address - Street 1:59 BANGOR ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1740
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2595
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5782225700000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist