Healthcare Provider Details

I. General information

NPI: 1588627251
Provider Name (Legal Business Name): JOSHUA R WELLINGTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11595 N MERIDIAN ST STE 402
CARMEL IN
46032-6947
US

IV. Provider business mailing address

29943 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-7246
  • Fax:
Mailing address:
  • Phone: 317-706-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number01058918A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01058918A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: