Provider Demographics
NPI:1912976523
Name:WETZEL, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:WETZEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:STE 2201
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9800
Mailing Address - Fax:913-588-9803
Practice Address - Street 1:2330 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE2201
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2005
Practice Address - Country:US
Practice Address - Phone:913-588-9800
Practice Address - Fax:913-588-9803
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2011-09-15
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Provider Licenses
StateLicense IDTaxonomies
KS0423041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE68682Medicare UPIN
KSJ61A00017Medicare PIN