Provider Demographics
NPI:1609829324
Name:WETZEL, JAMES LEROY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEROY
Last Name:WETZEL
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 1:20805 W 151ST ST
Mailing Address - Street 2:SUITE # 224
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7249
Mailing Address - Country:US
Mailing Address - Phone:913-782-8300
Mailing Address - Fax:913-782-1574
Practice Address - Street 1:20375 W 151ST
Practice Address - Street 2:STE # 301
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-782-8300
Practice Address - Fax:913-782-1574
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203050BMedicaid
KS0335712DMedicare ID - Type Unspecified
D16862Medicare UPIN