Individual
MARK OTTO WEISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 W DOTY ST, PHS MEDICAL OFFICE, MADISON, WI 53703-3276
(608) 284-6071
Mailing address
5391 MARINERS COVE DR, UNIT 202, MADISON, WI 53704-7615
(608) 241-5429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20893
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20893
LICENSE
WI
Enumeration date
12/06/2005
Last updated
07/08/2007
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