Provider Demographics
NPI:1972509784
Name:WEIERMILLER, BEATA KOSTRZEWA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:KOSTRZEWA
Last Name:WEIERMILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 444
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2914
Mailing Address - Country:US
Mailing Address - Phone:248-816-9200
Mailing Address - Fax:248-816-1017
Practice Address - Street 1:3290 W BIG BEAVER RD
Practice Address - Street 2:SUITE 444
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2914
Practice Address - Country:US
Practice Address - Phone:248-816-9200
Practice Address - Fax:248-816-1017
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M43750-001Medicare PIN
MI0M43750004Medicare PIN
MIG79147OtherHAP
MIG79147Medicare UPIN
MI063-2996OtherBCBS
MIC6307OtherMCARE