Provider Demographics
NPI:1972580207
Name:WEISZ, ALLA (MD)
Entity type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:WEISZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 WINDING BAY LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-3039
Mailing Address - Country:US
Mailing Address - Phone:317-985-9599
Mailing Address - Fax:561-421-3799
Practice Address - Street 1:3375 BURNS RD STE 207
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4361
Practice Address - Country:US
Practice Address - Phone:561-802-7999
Practice Address - Fax:561-421-3799
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200427560Medicaid
IN000000352337OtherANTHEM
INQ0429212OtherSHO
H81672Medicare UPIN
IN200427560Medicaid