Provider Demographics
NPI:1063601250
Name:WELTON, TODD CRAIG (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:CRAIG
Last Name:WELTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N KALAMAZOO MALL STE 100
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3899
Mailing Address - Country:US
Mailing Address - Phone:269-345-0273
Mailing Address - Fax:
Practice Address - Street 1:222 N KALAMAZOO MALL STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3899
Practice Address - Country:US
Practice Address - Phone:269-345-0273
Practice Address - Fax:269-345-8522
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI510105793207R00000X, 208000000X
MI5101015793207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BRONSON
MI1063601250Medicaid
MI1063601250Medicaid