Provider Demographics
NPI:1184032062
Name:WEYHRAUCH, DEREK L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:L
Last Name:WEYHRAUCH
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 1:743 E. BROADWAY #300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-584-3200
Mailing Address - Fax:502-584-3333
Practice Address - Street 1:731 E. BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-584-3200
Practice Address - Fax:502-584-3333
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10358523-12052080P0202X
MN59618208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics