Provider Demographics
NPI:1487694113
Name:WEBER, KATHARINA M (MD)
Entity type:Individual
Prefix:
First Name:KATHARINA
Middle Name:M
Last Name:WEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 N DAN JONES RD STE 161
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1896
Practice Address - Country:US
Practice Address - Phone:317-754-5080
Practice Address - Fax:317-754-5085
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059739A208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1043275787OtherANTHEM PTAN
IN000000758245OtherANTHEM PTAN
IN200187070Medicaid
INP01047720Medicare PIN
INM400065037Medicare PIN