Individual
MICHAEL CARL WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 VALLEY DR, VALPARAISO, IN 46383-2520
(219) 462-5195
(219) 462-5195
Mailing address
3705 QUAIL COVEY DR, VALPARAISO, IN 46383-2278
(219) 464-3941
(219) 464-3941
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01030965A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000090508
ANTHEM BLUE CROSS BLUE SH
IN
05
—
100208260A
—
IN
01
—
CA0402
RAILROAD MEDICARE
IN
Enumeration date
08/30/2006
Last updated
11/29/2012
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