Provider Demographics
NPI:1972009280
Name:WEISBERG-TANNENBAUM, MIRIAM DANIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:DANIELLE
Last Name:WEISBERG-TANNENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:WEISBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N FLAMINGO RD STE 213
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1009
Mailing Address - Country:US
Mailing Address - Phone:954-844-1223
Mailing Address - Fax:954-276-0594
Practice Address - Street 1:601 N FLAMINGO RD STE 213
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1009
Practice Address - Country:US
Practice Address - Phone:954-844-1223
Practice Address - Fax:954-276-0594
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD97796207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery