Provider Demographics
NPI:1972822617
Name:FREVERT, WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:FREVERT
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 1:120 NE SAINT LUKES BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6011
Mailing Address - Country:US
Mailing Address - Phone:816-246-4302
Mailing Address - Fax:
Practice Address - Street 1:120 NE SAINT LUKES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6011
Practice Address - Country:US
Practice Address - Phone:816-246-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020134207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine