MEDICARE: MR. MITCHAEL GORDON WELCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2025088	TX

General Provider Information

NPI Number	:	1750536918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHAEL GORDON WELCH

Provider Business Mailing Address
First Line	:	862 ABERDEEN AVE NE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-2856
Country	:	US
Telephone Number	:	512-299-7286
Fax Number	:

Provider Business Practice Location Address
First Line	:	862 ABERDEEN AVE NE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-2856
Country	:	US
Telephone Number	:	512-299-7286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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Directions to “ MR. MITCHAEL GORDON WELCH ” Practice Location

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