Provider Demographics
NPI:1689627507
Name:WEIDMAN, KEVIN A (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:WEIDMAN
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 1:950 N. 35TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208
Mailing Address - Country:US
Mailing Address - Phone:414-831-7939
Mailing Address - Fax:414-831-7954
Practice Address - Street 1:950 N. 35TH STREET
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-831-7939
Practice Address - Fax:414-831-7954
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36166208600000X, 207QA0401X, 207XS0114X
WI36166 HAND SURGERY207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32135100Medicaid
D25680Medicare UPIN
WI73851Medicare ID - Type Unspecified
WID25680Medicare UPIN
143467200OtherWORKERS COMP