Provider Demographics
NPI:1629076021
Name:WEIK, DAVID A (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WEIK
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 1:419 WEBSTER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3937
Mailing Address - Country:US
Mailing Address - Phone:314-882-6815
Mailing Address - Fax:314-963-1495
Practice Address - Street 1:5400 EXECUTIVE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2594
Practice Address - Country:US
Practice Address - Phone:314-882-6815
Practice Address - Fax:636-333-4510
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005256213E00000X
MO2008005998213E00000X
FLPO3090213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65816OtherBC/BS
FL3404111-00Medicaid
IL212382Medicare PIN
FL65816Medicare ID - Type Unspecified
IL212388Medicare PIN
ILU54280Medicare UPIN
FL3404111-00Medicaid
MOMA1594Medicare PIN
IL1120810001Medicare NSC