Weaver, Travis

Weaver, Travis is an individual health care provider with primary practice located at 1815 E Ireland Rd , South Bend IN 46614-2845. He recently has only one registered license in Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism, which is considered as his primary health care specialty. Weaver, Travis can be contacted via phone (574) 647-1700.

Contact Information

Primary practice address
1815 E Ireland Rd South Bend IN 46614-2845
Phone: (574) 647-1700
Fax: (574) 647-7572
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 0102204753 Virginia
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 02007513A Indiana

Profile Details

NPI number 1063808772
LBN Legal business name Weaver, Travis
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 9th, 2015
Last updated Dec 11th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063808772 NPPES
Indiana MEDICAID 300083607

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