Provider Demographics
NPI:1902858251
Name:WEBER, ANNICK OLGA (DO)
Entity Type:Individual
Prefix:
First Name:ANNICK
Middle Name:OLGA
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SISTER MARYSIA
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:20 ARCHBISHOP MAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5738
Mailing Address - Country:US
Mailing Address - Phone:314-792-7251
Mailing Address - Fax:314-792-7259
Practice Address - Street 1:20 ARCHBISHOP MAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5738
Practice Address - Country:US
Practice Address - Phone:314-792-7251
Practice Address - Fax:314-792-7259
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140208972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1006834OtherMCLAREN HEALTH PLAN
M020860OtherCHAMPVA
MI0984250OtherHEALTHPLUS
MI060014866OtherRAILROAD MEDICARE
MI700B960280OtherBCBS
MI1902858251Medicaid
MI1902858251Medicaid
MI1902858251Medicaid