Provider Demographics
NPI:1821082181
Name:WEISMANN, BRIAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PAUL
Last Name:WEISMANN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10220 WICKER AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9439
Mailing Address - Country:US
Mailing Address - Phone:219-365-3900
Mailing Address - Fax:219-365-5874
Practice Address - Street 1:10220 WICKER AVE
Practice Address - Street 2:STE A
Practice Address - City:ST JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9439
Practice Address - Country:US
Practice Address - Phone:219-365-3900
Practice Address - Fax:219-365-5874
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2012-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01046205A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000199317OtherBCBS
IN200123550BMedicaid
IN178930Medicare ID - Type Unspecified