Healthcare Provider Details

I. General information

NPI: 1114937398
Provider Name (Legal Business Name): LOUIS WESLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4000
  • Fax:
Mailing address:
  • Phone: 207-768-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD25590
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: