Provider Demographics
NPI:1265573281
Name:WEINER, LOWELL M (MD)
Entity type:Individual
Prefix:
First Name:LOWELL
Middle Name:M
Last Name:WEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1038
Mailing Address - Country:US
Mailing Address - Phone:734-645-1254
Mailing Address - Fax:
Practice Address - Street 1:1155 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1038
Practice Address - Country:US
Practice Address - Phone:734-645-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics