Healthcare Provider Details

I. General information

NPI: 1083610919
Provider Name (Legal Business Name): CATHERINE L WEIDEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 W CENTRAL PARK AVE STE 350
DAVENPORT IA
52804-1889
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4159
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4620
  • Fax: 563-421-4625
Mailing address:
  • Phone: 563-355-9191
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20640
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: