Provider Demographics
NPI:1366433054
Name:WEISSMAN, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15590 W 13 MILE RD
Mailing Address - Street 2:STE B
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5642
Mailing Address - Country:US
Mailing Address - Phone:248-483-5300
Mailing Address - Fax:248-483-5301
Practice Address - Street 1:15590 W 13 MILE RD
Practice Address - Street 2:STE B
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5642
Practice Address - Country:US
Practice Address - Phone:248-483-5300
Practice Address - Fax:248-483-5301
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4225125Medicaid
F37128031Medicare ID - Type Unspecified
MI4225125Medicaid