Provider Demographics
NPI:1790057230
Name:WEIKART HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:WEIKART HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WEIKART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-294-5900
Mailing Address - Street 1:1002 PERUQUE CROSSING CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5900
Mailing Address - Fax:636-294-5908
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5900
Practice Address - Fax:636-294-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5G33207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10605Medicare UPIN