Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 001073 | GA |
N | 208600000X | Surgeon | 001073 | GA |
Y | 208200000X | Surgeon | 4301099598 | MI |
Y | 208600000X | Surgeon | 4301099598 | MI |
N | 208200000X | Surgeon | T1019 | NH |
N | 208600000X | Surgeon | T1019 | NH |
NPI | 1013180876 |
---|---|
Provider Name | Dr. Kibwe Akin Weaver |
First Address | Kalamazoo, MI 49007-5341 |
Second Address | Kalamazoo, MI 49007-5341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0203907382 | BCBS (01) | MI |
1013180876 | (05) | MI |