Basic Information
Provider Information
NPI: 1396785564
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEINSTOCK
FirstName: MICHAEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 575 COPELAND MILL RD
Address2: SUITE #1D
City: WESTERVILLE
State: OH
PostalCode: 430818977
CountryCode: US
TelephoneNumber: 6147940481
FaxNumber: 6147943711
Practice Location
Address1: 500 S CLEVELAND AVE
Address2:  
City: WESTERVILLE
State: OH
PostalCode: 430818971
CountryCode: US
TelephoneNumber: 6147940481
FaxNumber: 6147943711
Other Information
ProviderEnumerationDate: 06/07/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X35063719-WOHY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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