Provider Demographics
NPI:1316607021
Name:WEITZEL, DAVID MARTIN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARTIN
Last Name:WEITZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 2ND ST STE 308
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5729
Mailing Address - Country:US
Mailing Address - Phone:701-223-4517
Mailing Address - Fax:
Practice Address - Street 1:1121 S 11TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6632
Practice Address - Country:US
Practice Address - Phone:701-751-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator