Provider Demographics
NPI:1316054372
Name:WELNIAK, LINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:WELNIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 RACINE STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1053
Mailing Address - Country:US
Mailing Address - Phone:920-674-6000
Mailing Address - Fax:920-674-3034
Practice Address - Street 1:840 RACINE STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1053
Practice Address - Country:US
Practice Address - Phone:920-674-6000
Practice Address - Fax:920-674-3034
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32160400Medicaid
BW3848946OtherDEA NUMBER
WI303450191Medicare PIN
G13058Medicare UPIN