Basic Information
| Provider Information | |||||||||
| NPI: | 1073572939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEITZ | ||||||||
| FirstName: | MATHIAS | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 N LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483713610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486282597 | ||||||||
| FaxNumber: | 2486288802 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 N LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483713610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486282597 | ||||||||
| FaxNumber: | 2486288802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 11/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101007986 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4535629 | 05 | MI | MEDICAID | OF31339 | 01 | MI | BCBS | OTHER |