Provider Demographics
NPI:1669555785
Name:WEBER, MARK DENNIS (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DENNIS
Last Name:WEBER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2333 PROGRESS RD
Mailing Address - Street 2:MARK WEBER MD
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661
Mailing Address - Country:US
Mailing Address - Phone:989-345-7474
Mailing Address - Fax:989-345-7033
Practice Address - Street 1:2333 PROGRESS RD
Practice Address - Street 2:MID MICHIGAN FAMILY ORTHOPAEDICS PC
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-345-7474
Practice Address - Fax:989-345-7033
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045177207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
06519252OtherBS
MI1831103Medicaid
06519252OtherBS
0651925Medicare ID - Type Unspecified