MEDICARE: KEVIN D. WELK 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
1	207RR0500X	Rheumatology Physician	22416	OK
2	207RR0500X	Rheumatology Physician	MD00049196	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	263667	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902804925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D. WELK MD

Provider Business Mailing Address
First Line	:	1400 E. KINCAID STREET
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2500
Fax Number	:	360-428-6485

Provider Business Practice Location Address
First Line	:	1400 E. KINCAID STREET
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2555
Fax Number	:	360-428-6402

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/03/2010

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Directions to “ KEVIN D. WELK MD” Practice Location

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