Provider Demographics
NPI:1932198397
Name:WEIKERT, MITCHELL P (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:P
Last Name:WEIKERT
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 1:6550 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-798-6100
Mailing Address - Fax:713-798-4231
Practice Address - Street 1:1977 BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-6100
Practice Address - Fax:713-798-4231
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159813802Medicaid
TX4259873OtherBLUE LINK
TX159813801Medicaid
TX8J3913OtherBC/BS
TX8J3913OtherBC/BS
TX8A9717Medicare PIN
H59873Medicare UPIN
TX8A9872Medicare PIN