Provider Demographics
NPI:1063728822
Name:MICHAEL WEIN MD PA
Entity type:Organization
Organization Name:MICHAEL WEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-299-7299
Mailing Address - Street 1:3375 20TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2427
Mailing Address - Country:US
Mailing Address - Phone:772-299-7299
Mailing Address - Fax:772-563-9191
Practice Address - Street 1:3375 20TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2427
Practice Address - Country:US
Practice Address - Phone:772-299-7299
Practice Address - Fax:772-563-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066191261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty