Healthcare Provider Details

I. General information

NPI: 1265759922
Provider Name (Legal Business Name): CASSIE ANN WELT D.O,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE AVE
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

1227 E RUSHOLME ST
DAVENPORT IA
52803-2459
US

V. Phone/Fax

Practice location:
  • Phone: 734-287-9029
  • Fax:
Mailing address:
  • Phone: 515-333-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO-04613
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberW4301018379508
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: