Healthcare Provider Details

I. General information

NPI: 1649228891
Provider Name (Legal Business Name): TIMOTHY S WELSCH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 N SUMMIT AVE
OCONOMOWOC WI
53066-4459
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-3080
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1518-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: