Basic Information
| Provider Information | |||||||||
| NPI: | 1720056054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALEWICZ | ||||||||
| FirstName: | DOROTA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5405 W 151ST ST | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662248700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133238830 | ||||||||
| FaxNumber: | 9133238831 | ||||||||
| Practice Location | |||||||||
| Address1: | 5405 W 151ST ST | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662248700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133238830 | ||||||||
| FaxNumber: | 9133238831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2006 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2004027810 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 04-37233 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 207264904 | 05 | MO | MEDICAID |