Basic Information
| Provider Information | |||||||||
| NPI: | 1407013527 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WELLIKOFF | ||||||||
| FirstName: | ADAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619674118 | ||||||||
| FaxNumber: | 5619673463 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619674118 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME124151 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | KW826 | 01 | FL | MEDICARE | OTHER |