Provider Demographics
NPI:1508857509
Name:WILT, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WILT
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 1:12140 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2504
Mailing Address - Country:US
Mailing Address - Phone:816-943-0706
Mailing Address - Fax:913-451-1754
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:SUITE 224
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-943-0706
Practice Address - Fax:816-943-6122
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9F92207R00000X
KS04-20602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208747303Medicaid
MO208747303Medicaid
MO5235736Medicare ID - Type UnspecifiedMEDICARE - MO AND KS