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General NPI Number Information
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NPI Number | 1790798593
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Entity Type | Individual
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Provider Name | LARRY L WELLENDORF II MD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 2236 N MERRITT CREEK LOOP STE A
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4960
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Country | US
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Telephone | 208-625-3670
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Fax | 208-625-3675
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Provider Business Mailing Address
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Address Line | 2003 KOOTENAI HEALTH WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-6051
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Country | US
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Telephone | 208-625-5084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036091551
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MC-2626
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License Number State | ID
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