Individual
DR. KATHLEEN B BAEVERSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
353 N OAK ST, COLUMBIA CITY, IN 46725-1623
(260) 248-9000
Mailing address
2414 E STATE BLVD, SUITE 202, FORT WAYNE, IN 46805-4760
(260) 482-4440
(260) 482-4442
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01032868A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000008456
MPLAN
—
01
—
000000082521
ANTHEM
IN
05
—
0801832
—
OH
Enumeration date
09/13/2005
Last updated
07/08/2007
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