Healthcare Provider Details

I. General information

NPI: 1821176223
Provider Name (Legal Business Name): KATHRYN A WEICHERT MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

6463 TAYLOR MILL RD
INDEPENDENCE KY
41051-9392
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-4983
  • Fax:
Mailing address:
  • Phone: 859-363-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35035158
License Number StateOH

VIII. Authorized Official

Name: MRS. BARBARA TEISL
Title or Position: ACCOUNT ADMINISTRATOR
Credential:
Phone: 859-363-4983