Kathleen B Baeverstad, MD
Individual provider Active NPI Emergency Medicine Physician · Columbia City, IN
NPI 1821083221 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821083221
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 01032868A (IN)
- Practice address
- 353 N Oak St
Columbia City, IN 46725-1623 - Phone
- (260) 248-9000
- NPI assigned
- Sep 13, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01032868A | IN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Emergency Physicians PC | Emergency Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01032868A | IN | Yes |
Addresses
Primary practice location
353 N Oak St
Columbia City, IN 46725-1623
Mailing address
2414 E State Blvd
Suite 202
Fort Wayne, IN 46805-4760
Phone (260) 482-4440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000082521 | Other | IN | ANTHEM |
| 000000008456 | Other | MPLAN | |
| 0801832 | Medicaid | OH |
Other providers in Columbia City, IN
- Cheryl L Allen
- Allied Physicians Inc., D/B/a Tri-State Physical Medicine
- Andrew Ott, LLC
- Amanda Kate Atz
- Angelyss Auer
- Jessica Baker
- Barbara Beck
- Katelyn M Beery
- James Beitzel
- Benchmark Physical Therapy Indiana LLC
All providers in Columbia City, IN · Emergency Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.