Individual
DR. DAVID LOUIS WEATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25 MICHIGAN ST NE STE 3300, GRAND RAPIDS, MI 49503-2558
(616) 459-4171
(616) 459-0044
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301096915
MI
208800000X
Urology Physician
Primary
4301096915
MI
2088P0231X
Pediatric Urology Physician
4301096915
MI
Other
Enumeration date
06/30/2010
Last updated
01/30/2024
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