Provider Demographics
NPI:1902073596
Name:WEBER, MICHAEL R (CNIM)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:WEBER
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-1288
Mailing Address - Country:US
Mailing Address - Phone:281-462-1285
Mailing Address - Fax:
Practice Address - Street 1:18302 NOYCE RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-7807
Practice Address - Country:US
Practice Address - Phone:281-462-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCNIM 1455246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic