Provider Demographics
NPI:1720056054
Name:WALEWICZ, DOROTA J (MD)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:J
Last Name:WALEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-8700
Mailing Address - Country:US
Mailing Address - Phone:913-323-8830
Mailing Address - Fax:913-323-8831
Practice Address - Street 1:5405 W 151ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8700
Practice Address - Country:US
Practice Address - Phone:913-323-8830
Practice Address - Fax:913-323-8831
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027810207R00000X
KS04-37233207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207264904Medicaid
KSG93000040Medicare PIN
MO207264904Medicaid