Provider Demographics
NPI:1235383472
Name:JAN J WEISBERG. MD
Entity Type:Organization
Organization Name:JAN J WEISBERG. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-227-9911
Mailing Address - Street 1:5 PHYSICIANS PARK
Mailing Address - Street 2:SUITE #4
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4163
Mailing Address - Country:US
Mailing Address - Phone:502-227-9911
Mailing Address - Fax:502-226-6455
Practice Address - Street 1:5 PHYSICIANS PARK
Practice Address - Street 2:SUITE #4
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4163
Practice Address - Country:US
Practice Address - Phone:502-227-9911
Practice Address - Fax:502-226-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26843207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
207Y00000XOtherTAXONOMY CODE
KY64268436Medicaid
KYA43131Medicare UPIN
KY1497501Medicare PIN