Provider Demographics
NPI:1013180876
Name:WEAVER, KIBWE AKIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIBWE
Middle Name:AKIN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-488-1524
Mailing Address - Fax:269-488-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-283
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-488-1524
Practice Address - Fax:269-488-1655
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHT1019208600000X
GA001073208600000X
MI4301099598208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013180876Medicaid
MI0203907382OtherBCBS
MI0203907382OtherBCBS