Basic Information
| Provider Information | |||||||||
| NPI: | 1750525614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEISSTUCH | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | SETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 WESTON RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543891414 | ||||||||
| FaxNumber: | 9543894201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 WESTON RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543891414 | ||||||||
| FaxNumber: | 9543894201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2009 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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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 | 207Y00000X | ME118624 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 011846900 | 05 | FL | MEDICAID |