Provider Demographics
NPI:1205128816
Name:WEISMILLER, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEISMILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:989-224-2338
Mailing Address - Fax:989-224-2065
Practice Address - Street 1:901 S OAKLAND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2200
Practice Address - Country:US
Practice Address - Phone:989-224-2338
Practice Address - Fax:989-224-2065
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301098816208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery