Provider Demographics
NPI:1427165067
Name:WEINSTEIN, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:WEINSTEIN
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 1:2953 CANDLELIGHT LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-6823
Mailing Address - Country:US
Mailing Address - Phone:760-619-2309
Mailing Address - Fax:866-428-0703
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:760-323-6605
Practice Address - Fax:760-323-6568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021629208100000X
CAG88894208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWE6606OtherBLUE SHIELD
WA1013036Medicaid
WAMD162WAOtherALASKA MEDICAID
WAUS0861510OtherAETNA/USHC SPECIALIST
WA0039622OtherLABOR & INDUSTRY
WA000182305Medicare PIN
WAWE6606OtherBLUE SHIELD