Basic Information
| Provider Information | |||||||||
| NPI: | 1124088125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3515 MASSILLON RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446857854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308999350 | ||||||||
| FaxNumber: | 3306341329 | ||||||||
| Practice Location | |||||||||
| Address1: | 3593 S ARLINGTON RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443125271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308999070 | ||||||||
| FaxNumber: | 3308990651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34006114W | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110167391 | 01 | OH | RAILROAD MEDICARE | OTHER | 2027210 | 05 | OH | MEDICAID | 000000132166 | 01 | OH | ANTHEM | OTHER | 729766 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER | 496 | 01 | OH | SUMMA | OTHER |