Healthcare Provider Details

I. General information

NPI: 1750331575
Provider Name (Legal Business Name): MICHELE WELLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 AMSDEN AVE SUITE 301
VERSAILLES KY
40383-1851
US

IV. Provider business mailing address

360 AMSDEN AVE SUITE 301
VERSAILLES KY
40383-1851
US

V. Phone/Fax

Practice location:
  • Phone: 859-873-1303
  • Fax: 859-879-6262
Mailing address:
  • Phone: 859-873-1303
  • Fax: 859-879-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29823
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: