Provider Demographics
NPI:1790868198
Name:WEINERT, ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:WEINERT
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 1:3272 E. 12 MILE RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:UM
Mailing Address - Phone:586-751-3338
Mailing Address - Fax:
Practice Address - Street 1:3272 E 12 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5622
Practice Address - Country:US
Practice Address - Phone:586-751-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001964213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84871Medicare UPIN
MI5532140001Medicare NSC
MIU84871Medicare UPIN
MIP15600001Medicare PIN