Provider Demographics
NPI:1659605061
Name:STELZER, DOLLY MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:MARIE
Last Name:STELZER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DOLLY
Other - Middle Name:MARIE
Other - Last Name:RAIHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1001 6TH AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 6TH AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3222
Practice Address - Country:US
Practice Address - Phone:913-651-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00400213ES0103X
MO2012014962213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13000002Medicare PIN