Provider Demographics
NPI:1912947433
Name:WEINHAUS, LARRY H (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:H
Last Name:WEINHAUS
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 1:700 S PARK ST
Mailing Address - Street 2:DEAN & ST. MARY'S OUTPATIENT CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-260-6000
Mailing Address - Fax:
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:DEAN & ST. MARY'S OUTPATIENT CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-260-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30268-0202080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31502600Medicaid
WI1796OtherDEAN HEALTH INSURANCE
WI1796OtherDEAN HEALTH INSURANCE
WI741501736Medicare PIN
WI543400515Medicare PIN
WI31502600Medicaid
WI060023127Medicare PIN