Individual
SARAH RENEE WIEDERHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5210 NORTH BELT HIGHWAY, ST JOSEPH, MO 64506-1211
(816) 271-4971
(816) 271-6010
Mailing address
5210 NORTH BELT HIGHWAY, ST JOSEPH, MO 64506-1211
(816) 271-4971
(816) 271-6010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2008003502
MO
207Q00000X
Family Medicine Physician
T2004018057
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528161304
—
MO
05
—
200552180A
—
KS
01
—
39921013
BLUE CROSS BLUE SHIELD OF KANSAS CIITY
MO
01
—
P00628597
RR MEDICARE
MO
Enumeration date
09/06/2006
Last updated
11/22/2017
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