Provider Demographics
NPI:1336230804
Name:WEISS, MIRIAM F (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:F
Last Name:WEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5096 DOGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2743
Mailing Address - Country:US
Mailing Address - Phone:440-449-8523
Mailing Address - Fax:440-974-1686
Practice Address - Street 1:8300 TYLER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4217
Practice Address - Country:US
Practice Address - Phone:440-266-5000
Practice Address - Fax:440-974-1686
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH053552207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675845Medicaid
OH0675845Medicaid
FR0602262Medicare ID - Type Unspecified