Provider Demographics
NPI:1730391061
Name:SUSAN H WEINKLE, MD
Entity type:Organization
Organization Name:SUSAN H WEINKLE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HOLLOWAY
Authorized Official - Last Name:WEINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-794-5432
Mailing Address - Street 1:5601 21ST AVE W
Mailing Address - Street 2:STE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5642
Mailing Address - Country:US
Mailing Address - Phone:941-794-5432
Mailing Address - Fax:941-794-5682
Practice Address - Street 1:5601 21ST AVE W
Practice Address - Street 2:STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5642
Practice Address - Country:US
Practice Address - Phone:941-794-5432
Practice Address - Fax:941-794-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45450207NS0135X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00301379OtherRAILROAD MEDICARE PIN
FL070005597OtherRAILROAD MEDICARE
FLDE5714OtherRAILROAD MEDICARE PTAN
FLDE5714OtherRAILROAD MEDICARE PTAN
FLK5859Medicare PIN
FL070005597OtherRAILROAD MEDICARE