Provider Demographics
NPI:1649260134
Name:ZHAO, WEIGUO (MD)
Entity type:Individual
Prefix:DR
First Name:WEIGUO
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E BROOMFIELD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4496
Mailing Address - Country:US
Mailing Address - Phone:989-779-5260
Mailing Address - Fax:989-779-5264
Practice Address - Street 1:1234 E BROOMFIELD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4496
Practice Address - Country:US
Practice Address - Phone:989-779-5260
Practice Address - Fax:989-779-5264
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010753562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4466174 10Medicaid
MI1303759612OtherBLUECROSS/BLUESHIELD
MI1303759612OtherBLUECROSS/BLUESHIELD
MI1303759612OtherBLUECROSS/BLUESHIELD