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General NPI Number Information
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NPI Number | 1649456583
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Entity Type | Organization
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Legal Business Name | MARVIN WELLEN, M.D.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 11/13/2009
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Provider Practice Location Address
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Address Line | 17971 BISCAYNE BLVD SUITE 208
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City | AVENTURA
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State | FL
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Zip | 33160-2578
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Country | US
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Telephone | 305-931-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 17971 BISCAYNE BLVD SUITE 208
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City | AVENTURA
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State | FL
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Zip | 33160-2578
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Country | US
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Telephone | 305-931-0555
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Fax |
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. MARVIN WELLEN
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Credential | M.D.
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Telephone | 305-931-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME35679
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License Number State | FL
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