1417999574 NPI number — IRWIN D WEISMAN M.D.

Table of content: IRWIN D WEISMAN M.D. (NPI 1417999574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417999574 NPI number — IRWIN D WEISMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEISMAN
Provider First Name:
IRWIN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417999574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 NICOLLET AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55403-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-573-2232
Provider Business Mailing Address Fax Number:
612-573-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 NICOLLET AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55403-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-573-2232
Provider Business Practice Location Address Fax Number:
612-573-2274
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  23681 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300123865 . This is a "RAILROAD MEDICARE MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 30706600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52F86WE . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 280877300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 596687 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P00287185 . This is a "RAILROAD MEDICARE WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1931915 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018007 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1601435 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 105662 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 300G2WE . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP33430 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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