Healthcare Provider Details

I. General information

NPI: 1629914155
Provider Name (Legal Business Name): WELLIFYCARE MEDICAL S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 W CAPITOL DR STE 200
BROOKFIELD WI
53045-1446
US

IV. Provider business mailing address

W193N4932 TEA TREE DR
MENOMONEE FALLS WI
53051-1644
US

V. Phone/Fax

Practice location:
  • Phone: 262-261-8880
  • Fax:
Mailing address:
  • Phone: 262-261-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0505X
TaxonomyDiabetology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1002X
TaxonomyPhysician Nutrition Specialist (Internal Medicine)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREJE TEFERA SIYUM
Title or Position: PRESIDENT
Credential: MD
Phone: 262-261-8880