Healthcare Provider Details

I. General information

NPI: 1518949049
Provider Name (Legal Business Name): MICHAEL H WELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

3 FLYING MANE RD
ROLLING HILLS CA
90274-5238
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-1550
  • Fax:
Mailing address:
  • Phone: 310-541-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberG12497
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG12497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: