Provider Demographics
NPI:1205044195
Name:WEEKS, LARA KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:KATHRYN
Last Name:WEEKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:KATHRYN
Other - Last Name:BUCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7644
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066853A207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000618966OtherANTHEM
IN000001024783OtherINTERNAL MED ANTHEM PIN UNDER TIN 35-2030653
IN200954280Medicaid
IN000001037742OtherPEDIATRIC ANTHEM PIN UNDER TIN 35-2030653
IN000001037742OtherPEDIATRIC ANTHEM PIN UNDER TIN 35-2030653
INP01783903Medicare PIN