MEDICARE: ADRIENNE WELLS

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
1	207L00000X	Anesthesiology Physician	036106754	IL

General Provider Information

NPI Number	:	1629173059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE WELLS

Provider Business Mailing Address
First Line	:	31500 NORTHWESTERN HWY STE 140
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2568
Country	:	US
Telephone Number	:	800-222-1442
Fax Number	:	248-477-7749

Provider Business Practice Location Address
First Line	:	1375 S LAPEER RD STE 109
Second Line	:
City	:	LAKE ORION
State	:	MI
Zip	:	48360-1421
Country	:	US
Telephone Number	:	800-222-1442
Fax Number	:	248-477-7749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/17/2018

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Directions to “ ADRIENNE WELLS ” Practice Location

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