Individual
DR. DANIEL TILLES WEIDENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25700 SCIENCE PARK DR, SUITE 190, BEACHWOOD, OH 44122-7319
(216) 464-5266
(216) 464-5290
Mailing address
25700 SCIENCE PARK DR, SUITE 400, BEACHWOOD, OH 44122-7319
(216) 464-5266
(216) 464-5290
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35023014W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000126756
ANTHEM
OH
05
—
0080095
—
OH
Enumeration date
07/11/2005
Last updated
07/08/2007
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