Basic Information
Provider Information | |||||||||
NPI: | 1689766826 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MICHAEL D. WEISS, MD, PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1130 TEN ROD RD | ||||||||
Address2: | D201 | ||||||||
City: | NORTH KINGSTOWN | ||||||||
State: | RI | ||||||||
PostalCode: | 028524161 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4012958655 | ||||||||
FaxNumber: | 4012958335 | ||||||||
Practice Location | |||||||||
Address1: | 5000 W OAKLAND PARK BLVD | ||||||||
Address2: |   | ||||||||
City: | LAUDERDALE LAKES | ||||||||
State: | FL | ||||||||
PostalCode: | 333131503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547356000 | ||||||||
FaxNumber: | 9546772614 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/28/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WEISS | ||||||||
AuthorizedOfficialFirstName: | MICHAEL | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | INTERVENTIONAL RADIOLOGIST | ||||||||
AuthorizedOfficialTelephone: | 4012958655 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | ME62895 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.