Provider Demographics
NPI:1760406748
Name:WEITZMAN, MARC (DPM)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:WEITZMAN
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 1:10425 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1113
Mailing Address - Country:US
Mailing Address - Phone:248-890-9171
Mailing Address - Fax:
Practice Address - Street 1:27901 WOODWARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-0920
Practice Address - Country:US
Practice Address - Phone:248-545-0100
Practice Address - Fax:248-545-1285
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMW000907213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883048Medicaid
MI5635006Medicare ID - Type Unspecified
MI1883048Medicaid