Provider Demographics
NPI:1841384773
Name:WESTON, WILLIAM F (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:WESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 NEWPORT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-9235
Mailing Address - Country:US
Mailing Address - Phone:269-343-4679
Mailing Address - Fax:269-343-5929
Practice Address - Street 1:6100 NEWPORT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-9235
Practice Address - Country:US
Practice Address - Phone:269-343-4679
Practice Address - Fax:269-343-5929
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301030057207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1260247Medicaid
OC96019002Medicare ID - Type Unspecified
B47844Medicare UPIN