Provider Demographics
NPI:1578605440
Name:STEPHEN A WEEBER DPM
Entity Type:Organization
Organization Name:STEPHEN A WEEBER DPM
Other - Org Name:ANKLE AND FOOT CENTER OF KETTERING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:WEEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-438-3338
Mailing Address - Street 1:5250 FAR HILLS AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2353
Mailing Address - Country:US
Mailing Address - Phone:937-438-3338
Mailing Address - Fax:937-438-3353
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:STE 220
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2353
Practice Address - Country:US
Practice Address - Phone:937-438-3338
Practice Address - Fax:937-438-3353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0167920001Medicare NSC