Provider Demographics
NPI:1083610919
Name:WEIDEMAN, CATHERINE L (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:WEIDEMAN
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 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:STE 350
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1889
Practice Address - Country:US
Practice Address - Phone:563-421-4620
Practice Address - Fax:563-421-4625
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20640207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
31101OtherWELLMARK BC/BS
IL01D6OtherJOHN DEERE HEALTH PLAN
19921OtherIOWA HEALTH SOLUTIONS
041678OtherHEALTH ALLIANCE
IA1201376Medicaid
A02128Medicare UPIN
041678OtherHEALTH ALLIANCE