Provider Demographics
NPI:1679760417
Name:FIELEKE, DAVID RYAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:FIELEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 NE NINE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-7814
Mailing Address - Country:US
Mailing Address - Phone:573-356-7265
Mailing Address - Fax:
Practice Address - Street 1:1728 NE NINE OAKS DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-7814
Practice Address - Country:US
Practice Address - Phone:573-356-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011N01449207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology