Provider Demographics
NPI:1619140001
Name:WEBER, CHRISTOPHER EDWARD
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:WEBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N112W15415 MEQUON RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-3410
Mailing Address - Country:US
Mailing Address - Phone:262-250-7800
Mailing Address - Fax:262-257-7980
Practice Address - Street 1:N112W15415 MEQUON RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-3410
Practice Address - Country:US
Practice Address - Phone:262-250-7800
Practice Address - Fax:262-257-7980
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54426-20208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics