Provider Demographics
NPI:1629082862
Name:WEINER, RONALD ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ELLIOTT
Last Name:WEINER
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 1:4601 W 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4129
Mailing Address - Country:US
Mailing Address - Phone:785-842-3778
Mailing Address - Fax:785-842-4219
Practice Address - Street 1:4601 W 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4129
Practice Address - Country:US
Practice Address - Phone:785-842-3778
Practice Address - Fax:785-842-4219
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18677174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100124700GMedicaid
KS100124700AMedicaid
KS100124700AMedicaid
KSD17331Medicare UPIN
KS019429Medicare ID - Type UnspecifiedTOPEKA OFFICE
KS106828Medicare PIN