Individual
DR. JOHN WEITLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 VIRGINIA ST, COLUMBIA, MO 65212-0001
(573) 882-5731
Mailing address
3107 FREDERICK AVE, STE B, SAINT JOSEPH, MO 64506-3082
(816) 233-9888
(816) 233-0414
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2020021403
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015020393
MISSOURI LICENSE
MO
Enumeration date
06/24/2015
Last updated
07/13/2020
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