Provider Demographics
NPI:1588758270
Name:WEISER, KIRSTEN TEANEY (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:TEANEY
Last Name:WEISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:URSULA
Other - Last Name:TEANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR STE 310
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845
Practice Address - Country:US
Practice Address - Phone:260-266-5230
Practice Address - Fax:260-266-5238
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14241207RG0100X
VT42-0010557207RG0100X
NC2008-01383207RG0100X
SD13660207RG0100X
NY294978207RG0100X
GA99004207RG0100X
IN01081385A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911911Medicaid
NC5911911Medicaid