Basic Information
| Provider Information | |||||||||
| NPI: | 1376713974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARNO W WEISS JR, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 COOPER AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897532061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 COOPER AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486025394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897532061 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | GRIESE | ||||||||
| AuthorizedOfficialFirstName: | PENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLER | ||||||||
| AuthorizedOfficialTelephone: | 9897532061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2082S0105X | 4301032786 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 2105235 | 05 | MI | MEDICAID |