Provider Demographics
NPI:1720079346
Name:WEINGARTEN, MARK D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WEINGARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6900
Mailing Address - Country:US
Mailing Address - Phone:248-650-2255
Mailing Address - Fax:248-650-0145
Practice Address - Street 1:1282 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6900
Practice Address - Country:US
Practice Address - Phone:248-650-2255
Practice Address - Fax:248-650-0145
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054440207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2964679-10Medicaid
F56489Medicare UPIN
MI2964679-10Medicaid
MI4118690001Medicare NSC