Provider Demographics
NPI:1376509018
Name:WEEKS, JONATHAN W (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:W
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 TOWNSHIP LINE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8081 TOWNSHIP LINE RD STE 203
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2189
Practice Address - Country:US
Practice Address - Phone:317-415-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064626A207VM0101X
KY29866207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100333880Medicaid
KY50018910OtherPASSPORT SPECIALTY # FOR PSC LOCATION
KY000000652640OtherANTHEM PSC LOCATION
KY000000566263OtherANTHEM FOUNDATION
KY50018907OtherPASSPORT PCP# FOR FOUNDATION LOCATION
KY64298664Medicaid
KY50018908OtherPASSPORT SPECIALTY# FOR FOUNDATION LOCATION
KY0979717Medicare PIN
KY50018908OtherPASSPORT SPECIALTY# FOR FOUNDATION LOCATION
KY64298664Medicaid