MEDICARE: DR. DAVID N WEIDENSAUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	0416898	KS
2	207RR0500X	Rheumatology Physician	04-16898	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103629	OTHER	KS	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942205851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID N WEIDENSAUL MD

Provider Business Mailing Address
First Line	:	1712 E. 23RD
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67502
Country	:	US
Telephone Number	:	620-960-1259
Fax Number	:	620-662-0538

Provider Business Practice Location Address
First Line	:	1701 EAST 23RD
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67502
Country	:	US
Telephone Number	:	316-612-4815
Fax Number	:	316-612-4825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/11/2013

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