Provider Demographics
NPI:1821176223
Name:KATHRYN A WEICHERT MD, INC.
Entity Type:Organization
Organization Name:KATHRYN A WEICHERT MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEISL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-363-4983
Mailing Address - Street 1:6463 TAYLOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9392
Mailing Address - Country:US
Mailing Address - Phone:859-363-4956
Mailing Address - Fax:
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:859-363-4983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHRYN A WEICHERT MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035158207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD287676Medicaid
OHD287676Medicaid
OH4040503Medicare ID - Type Unspecified
OH0422047Medicare ID - Type Unspecified
OH4040502Medicare ID - Type Unspecified
A75576Medicare UPIN
OH4040501Medicare ID - Type Unspecified
OH0422045Medicare ID - Type Unspecified
OH9374811Medicare PIN