Healthcare Provider Details

I. General information

NPI: 1093251142
Provider Name (Legal Business Name): WEIK PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 EXECUTIVE CENTRE PKWY
SAINT PETERS MO
63376-2594
US

IV. Provider business mailing address

419 WEBSTER FOREST DR
SAINT LOUIS MO
63119-3937
US

V. Phone/Fax

Practice location:
  • Phone: 314-882-6815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID WEIK
Title or Position: DPM/OWNER
Credential:
Phone: 314-882-6815