Provider Demographics
NPI:1336218650
Name:WEIN, MICHAEL BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:WEIN
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 1:3375 20TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2427
Mailing Address - Country:US
Mailing Address - Phone:772-299-7299
Mailing Address - Fax:
Practice Address - Street 1:3375 20TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2427
Practice Address - Country:US
Practice Address - Phone:772-299-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066191207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375839700Medicaid
FL25331AMedicare ID - Type Unspecified
FL375839700Medicaid