Individual
BRENDA WEINGARTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202
(313) 916-7425
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(313) 916-7425
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
4301406120
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301406120
MI
2085U0001X
Diagnostic Ultrasound Physician
4301406120
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4834010
—
MI
01
—
700F372090
BLUE SHIELD
MI
Enumeration date
05/05/2006
Last updated
08/03/2018
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