Provider Demographics
NPI:1740285378
Name:WEIMERT, THOMAS A (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:WEIMERT
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 1:5333 MCAULEY DR
Mailing Address - Street 2:RM 2017
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1096
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3209
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:RM 2017
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1096
Practice Address - Country:US
Practice Address - Phone:734-434-3200
Practice Address - Fax:734-434-3209
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITW034716207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1315167Medicaid
MIB6940OtherMCARE PROVIDER ID
MITW034716OtherMI LICENSE NUMBER
MI103820OtherCARE CHOICE PROVIDER ID
MI040004232OtherRAILROAD MEDICARE
MITW034716OtherMI LICENSE NUMBER
MI0H16076002Medicare ID - Type UnspecifiedMEDICARE
MI1315167Medicaid
MIA74551Medicare UPIN