Provider Demographics
NPI:1144487554
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:A
Authorized Official - Last Name:TEISL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-651-9660
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:513-651-9660
Mailing Address - Fax:513-241-2962
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:513-651-9660
Practice Address - Fax:513-241-2962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KATHRYN A WEICHERT MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350351582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287676Medicaid
OH4040502Medicare PIN
OH0287676Medicaid