1205044195 NPI number — LARA KATHRYN WEEKS M.D.

Table of content: JENNIFER A LUSHECK CNP (NPI 1619210333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205044195 NPI number — LARA KATHRYN WEEKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEKS
Provider First Name:
LARA
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUCHE
Provider Other First Name:
LARA
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205044195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SOUTHFIELD DR STE 1370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46168-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-837-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 SOUTHFIELD DR STE 1220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46168-4499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-838-3443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01066853A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 01066853A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000618966 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200954280 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000001024783 . This is a "INTERNAL MED ANTHEM PIN UNDER TIN 35-2030653" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000001037742 . This is a "PEDIATRIC ANTHEM PIN UNDER TIN 35-2030653" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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