Provider Demographics
NPI:1124088125
Name:WELLS, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:STE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7854
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:3593 S ARLINGTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5271
Practice Address - Country:US
Practice Address - Phone:330-899-9070
Practice Address - Fax:330-899-0651
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006114W207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110167391OtherRAILROAD MEDICARE
OH2027210Medicaid
OH000000132166OtherANTHEM
OH729766OtherBUCKEYE COMMUNITY HEALTH
OH496OtherSUMMA
OHG50942Medicare UPIN
OH2027210Medicaid