MEDICARE: CATHERINE L WEIDEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	20640	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	31101	OTHER	WELLMARK BC/BS
2	IL01D6	OTHER	JOHN DEERE HEALTH PLAN
3	19921	OTHER	IOWA HEALTH SOLUTIONS
4	041678	OTHER	HEALTH ALLIANCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083610919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE L WEIDEMAN MD

Provider Business Mailing Address
First Line	:	865 LINCOLN RD
Second Line	:	STE L10
City	:	BETTENDORF
State	:	IA
Zip	:	52722-4159
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	1351 W CENTRAL PARK AVE
Second Line	:	STE 350
City	:	DAVENPORT
State	:	IA
Zip	:	52804-1889
Country	:	US
Telephone Number	:	563-421-4620
Fax Number	:	563-421-4625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	07/09/2007

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Directions to “ CATHERINE L WEIDEMAN MD” Practice Location

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