Provider Demographics
NPI:1043386980
Name:WEILL, D. MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:D.
Middle Name:MICHAEL
Last Name:WEILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13115 KESWICK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1921
Mailing Address - Country:US
Mailing Address - Phone:323-462-1491
Mailing Address - Fax:323-285-5444
Practice Address - Street 1:13115 KESWICK ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1921
Practice Address - Country:US
Practice Address - Phone:323-462-1491
Practice Address - Fax:323-285-5444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2275213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11254Medicare UPIN
CAE2275Medicare ID - Type Unspecified