Provider Demographics
NPI:1609898642
Name:WEBER, KARSTEN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:KARSTEN
Middle Name:S
Last Name:WEBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 CITIZENS BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3959
Mailing Address - Country:US
Mailing Address - Phone:352-728-1252
Mailing Address - Fax:352-728-0079
Practice Address - Street 1:1330 CITIZENS BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3959
Practice Address - Country:US
Practice Address - Phone:352-728-1252
Practice Address - Fax:352-728-0079
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3114213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65909OtherBLUE CROSS BLUE SHIELD
FL280480800Medicaid
FL5875470001Medicare NSC
FL280480800Medicaid
FLU5528XMedicare PIN
FLU5528YMedicare PIN