Provider Demographics
NPI:1306414560
Name:WELCH, MIKAYLA ROSE (DO)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:WELCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:ROSE
Other - Last Name:KNAEBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1434
Mailing Address - Country:US
Mailing Address - Phone:573-882-0808
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1406
Practice Address - Country:US
Practice Address - Phone:573-882-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024018319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty