Provider Demographics
NPI:1912005851
Name:WEILERT, STEVEN VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:VINCENT
Last Name:WEILERT
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 1:701 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-2403
Mailing Address - Country:US
Mailing Address - Phone:620-223-5032
Mailing Address - Fax:620-223-5071
Practice Address - Street 1:701 W 8TH ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2403
Practice Address - Country:US
Practice Address - Phone:620-223-5032
Practice Address - Fax:620-223-5071
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-22773207ZP0102X
MOMDR2J35207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO702686106Medicaid
220009243OtherRAILROAD MEDICARE
KS100130640AMedicaid
KS100130640AMedicaid
220009243OtherRAILROAD MEDICARE