Healthcare Provider Details

I. General information

NPI: 1376509018
Provider Name (Legal Business Name): JONATHAN W WEEKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 DUTCHMANS LN SUITE 515
LOUISVILLE KY
40207-4707
US

IV. Provider business mailing address

8081 TOWNSHIP LINE RD STE 203
INDIANAPOLIS IN
46260-2189
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-6907
  • Fax: 502-899-6905
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number01064626A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number29866
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: