1609834019 NPI number — MARK WEISS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609834019 NPI number — MARK WEISS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WEISS

Provider First Name:

MARK

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1609834019

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/09/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1141 SPRINGBORROW DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FLINT

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48532-2141

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

810-230-8353

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

G3239 BEECHER RD

Provider Second Line Business Practice Location Address:

SUITE F

Provider Business Practice Location Address City Name:

FLINT

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48532-3616

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

810-733-6780

Provider Business Practice Location Address Fax Number:

810-733-6939

Provider Enumeration Date:

05/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0204X , with the licence number:  4301050600 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1020941 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1020941 . This is a "MHP FENTON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 0990536 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4020942 . This is a "MCLAREN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 4822485100 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4891811 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4891787 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 1608119 . This is a "FIRST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 230141 . This is a "HAP/HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 4822449100 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4822494100 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: RA820073 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".