Basic Information
| Provider Information | |||||||||
| NPI: | 1114909579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 347 | ||||||||
| Address2: | 250 S MAIN ST | ||||||||
| City: | EUREKA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893160347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752375313 | ||||||||
| FaxNumber: | 7752375073 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 893160347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752375313 | ||||||||
| FaxNumber: | 7752375073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101013720 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | O-0437 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO1828 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.