Provider Demographics
NPI:1376563361
Name:WEBER, ANDREW R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:WEBER
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 1:510 N 17TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4254
Mailing Address - Country:US
Mailing Address - Phone:715-842-7707
Mailing Address - Fax:
Practice Address - Street 1:510 N 17TH AVE STE A
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4254
Practice Address - Country:US
Practice Address - Phone:715-842-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47284208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34652700Medicaid
WI34652700Medicaid
WI006239315Medicare ID - Type Unspecified