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NPI Code Detail

MEDICARE: KATHLEEN M WELCH-WILSON MD

MEDICARE: KATHLEEN M WELCH-WILSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME0047118FL
2207Q00000XFamily Medicine PhysicianME47118FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01694655OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053453878
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN M WELCH-WILSON MD
Provider Business Mailing Address
First Line : PO BOX 947407
Second Line :
City : ATLANTA
State : GA
Zip : 30394-7407
Country : US
Telephone Number : 941-917-2600
Fax Number : 941-917-7884
Provider Business Practice Location Address
First Line : 1407 VISCAYA PKWY STE 2
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-6200
Country : US
Telephone Number : 239-772-0111
Fax Number : 239-772-0267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 01/30/2023

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