Provider Demographics
NPI:1740280197
Name:WEINSTEIN, MICHAEL STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 420858
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0858
Mailing Address - Country:US
Mailing Address - Phone:404-250-1153
Mailing Address - Fax:404-303-0317
Practice Address - Street 1:5730 GLENRIDGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-250-1153
Practice Address - Fax:404-303-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033485207L00000X
GA33485207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000525995FMedicaid