Provider Demographics
NPI:1922094986
Name:WEISS, MICHAEL IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IVAN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1347
Mailing Address - Country:US
Mailing Address - Phone:813-782-8761
Mailing Address - Fax:813-783-6038
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:813-782-8761
Practice Address - Fax:813-783-6038
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82245207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05006OtherBCBS
FL265125400Medicaid
FL265125400Medicaid
FL05006YMedicare PIN