Individual
DR. JONATHAN WADE WEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Mailing address
620 W EDISON RD, SUITE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
(574) 258-1101
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
01065200A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
47571-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200949650
—
IN
Enumeration date
10/26/2006
Last updated
05/16/2013
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