Doctor Name: | DR. MICHAEL IRA WEISMAN |
NPI Number: | 1043316219 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 016003033 |
Business Practice Address: | 400 Lake Cook Rd Suite 101 Deerfield, IL - 600155607 |
Business Phone Number: | 8479409880 |
Business Fax Number: | 8479409890 |
Mailing Address: | 400 Lake Cook Rd, Suite 101 DEERFIELD |
State: | IL |
Postal Code: | 600155607 |
Phone Number: | 8479409880 |
Fax Number: | 8479409890 |
NPI Enumeration Date: | 09/15/2006 |
NPI Last Update Date: | 03/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0131X |
License Number: | 016003033 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot Surgery |
Taxonomy Definition: |