Individual
DR. RONALD ALAN WEISBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1996 WALDEN DR, GAYLORD, MI 49735-8241
(989) 731-4111
(989) 705-8511
Mailing address
829 N CENTER AVE, STE 298, GAYLORD, MI 49735-1683
(989) 731-7708
(989) 731-7929
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101008157
MI
208D00000X
General Practice Physician
5101008157
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0156910075
BCBSM PROVIDER NUMBER
MI
01
—
11291805
CAQH PROVIDER ID
—
01
—
381303843
TAX ID
—
05
—
4540496
—
MI
01
—
CC4805
MEDICARE RR PROV ID
—
01
—
OF96004
MEDICARE GROUP NUMBER
—
Enumeration date
07/12/2006
Last updated
12/31/2020
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