Provider Demographics
NPI:1174798946
Name:MICKEY WEISZ MD PC
Entity type:Organization
Organization Name:MICKEY WEISZ MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-804-1818
Mailing Address - Street 1:PO BOX 371323
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1323
Mailing Address - Country:US
Mailing Address - Phone:702-804-1818
Mailing Address - Fax:702-804-1720
Practice Address - Street 1:7150 SMOKE RANCH RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3157
Practice Address - Country:US
Practice Address - Phone:702-804-1818
Practice Address - Fax:702-804-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ340896Medicaid
AZ340896Medicaid