Individual
MYRA J WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1695 W 12 MILE ROAD, SUITE 200, BERKLEY, MI 48072-2100
(248) 548-9090
(248) 548-8462
Mailing address
1695 W 12 MILE ROAD, SUITE 200, BERKLEY, MI 48072-2100
(248) 548-9090
(248) 548-8462
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301036736
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2899338
—
MI
Enumeration date
07/27/2006
Last updated
07/08/2007
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