Provider Demographics
NPI:1003870320
Name:WEBSTER, SUE H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:H
Last Name:WEBSTER
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 1:400 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-2225
Mailing Address - Country:US
Mailing Address - Phone:765-584-6600
Mailing Address - Fax:765-584-6503
Practice Address - Street 1:400 S OAK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-2225
Practice Address - Country:US
Practice Address - Phone:765-584-6600
Practice Address - Fax:765-584-6503
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048586208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN147670BMedicare ID - Type Unspecified
ING74512Medicare UPIN