Healthcare Provider Details

I. General information

NPI: 1821060294
Provider Name (Legal Business Name): MICHAEL WELLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/27/2023
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-1734
US

IV. Provider business mailing address

6626 E 75TH STREET STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-1800
  • Fax: 317-355-1803
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01039687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: