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General NPI Number Information
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NPI Number | 1265875959
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Entity Type | Organization
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Legal Business Name | WELLCARE PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 6135 TRUST DR SUITE 114
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City | HOLLAND
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State | OH
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Zip | 43528-9358
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Country | US
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Telephone | 419-491-0041
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Fax | 419-491-0042
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Provider Business Mailing Address
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Address Line | 6135 TRUST DR SUITE 114
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City | HOLLAND
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State | OH
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Zip | 43528-9358
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Country | US
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Telephone | 419-491-0041
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Fax | 419-491-0042
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | AMY L BAHNSEN
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Credential |
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Telephone | 419-824-7334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | OH
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