Basic Information
| Provider Information | |||||||||
| NPI: | 1710146980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELSCH | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7930 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216725 | ||||||||
| FaxNumber: | 3176214545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01066309A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 32554 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 32554 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 390200000X | 11012335A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XS0106X | 01066309A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200947780 | 05 | IN | MEDICAID | P01512455 | 01 | IN | RR MEDICARE | OTHER | 000000623916 | 01 | IN | ANTHEM PROVIDER NUMBER | OTHER | 32554 | 05 | SC | MEDICAID |