Healthcare Provider Details

I. General information

NPI: 1558567636
Provider Name (Legal Business Name): WELLCARE PHYSICIANS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 MONCLOVA RD
MAUMEE OH
43537-1841
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4231
US

V. Phone/Fax

Practice location:
  • Phone: 419-891-8024
  • Fax:
Mailing address:
  • Phone: 419-214-4214
  • Fax: 419-479-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89211
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: KERRY BURMEISTER
Title or Position: ADMINISTRATIVE DIRECTOR, FINANCE
Credential:
Phone: 419-891-8024