Provider Demographics
NPI:1720067606
Name:WEAVER, DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29150 BUCKINGHAM ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-7502
Mailing Address - Country:US
Mailing Address - Phone:734-207-9999
Mailing Address - Fax:734-838-0052
Practice Address - Street 1:7300 N CANTON CENTER RD
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1579
Practice Address - Country:US
Practice Address - Phone:734-454-8002
Practice Address - Fax:734-454-2733
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008321207P00000X, 207R00000X
VA0102202236207P00000X
PAOS014356207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720067606Medicaid
11293324OtherCAQH