Provider Demographics
NPI:1801963152
Name:WEISS, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:WEISS
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 1:420 W MAGNETIC ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2711
Mailing Address - Country:US
Mailing Address - Phone:906-228-9440
Mailing Address - Fax:
Practice Address - Street 1:420 W MAGNETIC ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2711
Practice Address - Country:US
Practice Address - Phone:906-228-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039795207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34031500Medicaid
MI2746802OtherMOLINA HEALTHCARE
MI1022269OtherPREFERRED ONE
MI220014258OtherRAILROAD MEDICARE
MI2746802OtherHEALTHPLAN OF MI
MI2746802Medicaid
MI0E26202003Medicare ID - Type Unspecified
MI220014258OtherRAILROAD MEDICARE
MI2746802OtherHEALTHPLAN OF MI
MIB48403Medicare UPIN