Provider Demographics
NPI:1457425662
Name:WEAVER, HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4401 N CAMPUS RIDGE DR
Mailing Address - Street 2:SUITE D2050
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6112
Mailing Address - Country:US
Mailing Address - Phone:989-837-9435
Mailing Address - Fax:989-837-9440
Practice Address - Street 1:4401 N CAMPUS RIDGE DR
Practice Address - Street 2:SUITE D2050
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6112
Practice Address - Country:US
Practice Address - Phone:989-837-9435
Practice Address - Fax:989-837-9440
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-09-17
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Provider Licenses
StateLicense IDTaxonomies
MIHW037687207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA73339Medicare UPIN