Basic Information
| Provider Information | |||||||||
| NPI: | 1386626562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539591049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087683900 | ||||||||
| FaxNumber: | 6085241947 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 N DEWEY AVE | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539591049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087683900 | ||||||||
| FaxNumber: | 6085241947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 28989 | WI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 16008 | 01 | WI | DEAN HEALTH INSURANCE | OTHER | 31575100 | 05 | WI | MEDICAID | W010562 | 01 | CHAMPUS | OTHER | 0676320001 | 01 | WI | MEDICARE DME | OTHER | 1386626562 | 01 | WI | PHYSICIANS PLUS | OTHER | 000257010 | 01 | WI | MEDICARE PROVIDER ID NUMBER | OTHER | 504547638 | 01 | WI | TRICARE | OTHER |