Healthcare Provider Details

I. General information

NPI: 1487694113
Provider Name (Legal Business Name): KATHARINA M WEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N DAN JONES RD STE 161
PLAINFIELD IN
46168-1896
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-754-5080
  • Fax: 317-754-5085
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01059739A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01059739A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1043275787
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PTAN
# 2
Identifier000000758245
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerANTHEM PTAN
# 3
Identifier200187070
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: