Weiss, Jonathan Wade

Weiss, Jonathan Wade is an individual health care provider with primary practice located at 620 W Edison Rd Suite 110, Mishawaka IN 46545-2784. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Nuclear Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Weiss, Jonathan Wade can be contacted via phone (574) 258-1100.

Contact Information

Primary practice address
620 W Edison Rd Suite 110 Mishawaka IN 46545-2784
Phone: (574) 258-1100
Fax: (574) 258-1101
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 47571-020 Wisconsin
Allopathic & Osteopathic Physicians / Nuclear Radiology 2085N0904X 01065200A Indiana

Profile Details

NPI number 1881779700
LBN Legal business name Weiss, Jonathan Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 26th, 2006
Last updated May 16th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881779700 NPPES
Indiana MEDICAID 200949650

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