Organization
JM WEIDA MD CJ SONDGERATH MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA JANE ODLE (INSURANCE SPECIALIST)
(765) 447-3103
Entity
Organization
Contact information
Practice address
3005 GREENBUSH ST, LAFAYETTE, IN 47904-2435
(765) 447-3103
(765) 449-4782
Mailing address
3005 GREENBUSH ST, LAFAYETTE, IN 47904-2435
(765) 447-3103
(765) 449-4782
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375905
GROUP ANTHEM NUMBER
IN
05
—
200325640A
—
IN
Enumeration date
06/28/2007
Last updated
05/19/2008
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