Provider Demographics
NPI:1043258890
Name:WEISS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6015
Mailing Address - Country:US
Mailing Address - Phone:239-454-2666
Mailing Address - Fax:
Practice Address - Street 1:63 BARKLEY CIR
Practice Address - Street 2:STE. 100 & 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4514
Practice Address - Country:US
Practice Address - Phone:239-938-3500
Practice Address - Fax:239-278-0588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00661352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79348Medicare UPIN
FL25239TMedicare ID - Type UnspecifiedFL RAD LEASING
FL25239UMedicare ID - Type UnspecifiedFL RAD CONSULTANTS