Individual
STACI L WEDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
855 A AVE NE, SUITE 300, CEDAR RAPIDS, IA 52402-5057
(319) 368-9300
(319) 368-5690
Mailing address
855 A AVE NE, SUITE 300, CEDAR RAPIDS, IA 52402-5057
(319) 368-9300
(319) 368-5690
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
31367
KS
208000000X
Pediatrics Physician
Primary
37934
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102549
HPK
KS
01
—
104840
BCBS
KS
05
—
1083623250
—
IA
01
—
12149415
MULTIPLAN
KS
01
—
14746
PHS
KS
05
—
200333240A
—
KS
01
—
244545
COVENTRY
KS
Enumeration date
08/06/2006
Last updated
10/27/2011
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