Provider Demographics
NPI:1548294259
Name:WEIS, WILLIAM W (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:WEIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:331 E PUETZ RD
Mailing Address - Street 2:#105
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154
Mailing Address - Country:US
Mailing Address - Phone:414-768-9933
Mailing Address - Fax:414-768-9936
Practice Address - Street 1:331 E PUETZ RD
Practice Address - Street 2:#105
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:414-768-9933
Practice Address - Fax:414-768-9936
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI629025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43210900Medicaid
WI1322610001Medicare NSC
WI000180620Medicare PIN
WI000180610Medicare PIN
T95295Medicare UPIN