1114099835 NPI number — HAROLD WEISS MD&MARK HAIMANN MD&JOEL MILLER MD&SUSAN MALINOWSKI MD

Table of content: (NPI 1114099835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114099835 NPI number — HAROLD WEISS MD&MARK HAIMANN MD&JOEL MILLER MD&SUSAN MALINOWSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD WEISS MD&MARK HAIMANN MD&JOEL MILLER MD&SUSAN MALINOWSKI MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RETINA CONSULTANTS OF MICHIGAN, PLC
Provider Other Organization Name Type Code:
3
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:
1114099835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29201 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 606
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-356-8610
Provider Business Mailing Address Fax Number:
248-356-6406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29201 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 606
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-356-8610
Provider Business Practice Location Address Fax Number:
248-356-6406
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEISS
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
248-356-5034

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2598450 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4549310 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1439727 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1532688 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4151694 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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