Provider Demographics
NPI:1033387949
Name:WILLIAM D. WEITZEL M.D., P.S.C.
Entity type:Organization
Organization Name:WILLIAM D. WEITZEL M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-277-5419
Mailing Address - Street 1:1725 HARRODSBURG RD
Mailing Address - Street 2:SUITE #128
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3601
Mailing Address - Country:US
Mailing Address - Phone:859-277-5419
Mailing Address - Fax:859-277-0929
Practice Address - Street 1:1725 HARRODSBURG ROAD
Practice Address - Street 2:SUITE #128
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3628
Practice Address - Country:US
Practice Address - Phone:859-277-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1065501Medicare PIN
KYC69714Medicare UPIN