Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2275 | CA |
Y | 222Z00000X | Podiatrist | E2275 | CA |
NPI | 1043386980 |
---|---|
Provider Name | Dr. D. Michael Weill |
First Address | Los Angeles, CA 90004 |
Second Address | Los Angeles, CA 90004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 23/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11254 | (02) | CA |