Individual
KENNETH L WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(305) 243-5512
(305) 243-4613
Mailing address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(305) 243-5512
(305) 243-4613
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35-05-2264
OH
2085R0202X
Diagnostic Radiology Physician
Primary
ME86986
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000199157
ANTHEM
OH
05
—
200343060
—
IN
05
—
2032017
—
OH
01
—
2591054
AETNA
OH
05
—
3810002515
—
WV
05
—
64037559
—
KY
01
—
P01212498
RAILROAD MEDICARE
MS
Enumeration date
06/29/2006
Last updated
08/10/2015
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