Basic Information
Provider Information | |||||||||
NPI: | 1427165067 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WEINSTEIN | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2953 CANDLELIGHT LN | ||||||||
Address2: |   | ||||||||
City: | PALM SPRINGS | ||||||||
State: | CA | ||||||||
PostalCode: | 922646823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7606192309 | ||||||||
FaxNumber: | 8664280703 | ||||||||
Practice Location | |||||||||
Address1: | 1150 N INDIAN CANYON DR | ||||||||
Address2: |   | ||||||||
City: | PALM SPRINGS | ||||||||
State: | CA | ||||||||
PostalCode: | 922624872 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7603236605 | ||||||||
FaxNumber: | 7603236568 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2006 | ||||||||
LastUpdateDate: | 11/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD00021629 | WA | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208100000X | G88894 | CA | Y |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
ID Information
ID | Type | State | Issuer | Description | WE6606 | 01 | WA | BLUE SHIELD | OTHER | 1013036 | 05 | WA |   | MEDICAID | MD162WA | 01 | WA | ALASKA MEDICAID | OTHER | US0861510 | 01 | WA | AETNA/USHC SPECIALIST | OTHER | 0039622 | 01 | WA | LABOR & INDUSTRY | OTHER |