Individual
DR. JAMES L WEATHERHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1005 W GREEN ST, SUITE G100, HASTINGS, MI 49058-1712
(269) 948-7820
(269) 948-2458
Mailing address
1005 W GREEN ST, SUITE G100, HASTINGS, MI 49058-1712
(269) 948-7820
(269) 948-2458
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301032093
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080058179
RAILROAD MEDICARE
MI
01
—
0800822151
BLUE CROSS BLUE SHIELD
MI
05
—
209975510
—
MI
Enumeration date
10/12/2005
Last updated
01/20/2009
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