Provider Demographics
NPI:1477627545
Name:WEINER, MICHAEL SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:WEINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4911
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4650 S HAGADORN RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5386
Practice Address - Country:US
Practice Address - Phone:517-353-4941
Practice Address - Fax:517-432-3145
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202637207R00000X
MIEMC0002839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine