Provider Demographics
NPI:1780750802
Name:WEIL, MICHAEL K (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:WEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-1125
Mailing Address - Country:US
Mailing Address - Phone:985-690-6600
Mailing Address - Fax:985-690-9860
Practice Address - Street 1:380 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5540
Practice Address - Country:US
Practice Address - Phone:985-690-6600
Practice Address - Fax:985-690-9860
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA12595R207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA070016132OtherMEDICARE RAIL ROAD
LA721481637001OtherTRICARE SOUTH
LA1537811Medicaid
LA1537811Medicaid
G74952Medicare UPIN
LA5A330Medicare ID - Type Unspecified