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NPI Code Detail

MEDICARE: DR. LORRAINE C NOVICH-WELTER MD

MEDICARE: DR. LORRAINE C NOVICH-WELTER 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
1208100000XPhysical Medicine & Rehabilitation Physician5924248-1205UT
2208100000XPhysical Medicine & Rehabilitation PhysicianM-10473ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111004941OTHERIDMEDICARE PTAN

General Provider Information

NPI Number : 1497741383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LORRAINE C NOVICH-WELTER MD
Provider Business Mailing Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-792-9400
Fax Number : 435-792-4800
Provider Business Practice Location Address
First Line : 267 N SPRING CREEK PKWY
Second Line :
City : PROVIDENCE
State : UT
Zip : 84332-9775
Country : US
Telephone Number : 435-792-9400
Fax Number : 435-792-4800
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 11/09/2021

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