Provider Demographics
NPI:1194816215
Name:WESSELOWSKI, BARRY EUGENE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:EUGENE
Last Name:WESSELOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3100
Mailing Address - Country:US
Mailing Address - Phone:620-331-1840
Mailing Address - Fax:620-331-7530
Practice Address - Street 1:209 N 6TH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3100
Practice Address - Country:US
Practice Address - Phone:620-331-1840
Practice Address - Fax:620-331-7530
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200262213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100227320BMedicaid
KS114035Medicare ID - Type Unspecified
KS100227320BMedicaid
KS0245660001Medicare NSC