Provider Demographics
NPI:1043205750
Name:WUELLNER, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:WUELLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7542
Mailing Address - Country:US
Mailing Address - Phone:660-827-2526
Mailing Address - Fax:660-827-5536
Practice Address - Street 1:1712 S LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7542
Practice Address - Country:US
Practice Address - Phone:660-827-2526
Practice Address - Fax:660-827-5536
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8C78207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201843703Medicaid
MO6486124Medicare PIN
C50544Medicare UPIN