Provider Demographics
NPI:1891764957
Name:WELCH, MICHELLE DAWN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4118 POND HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1281
Mailing Address - Country:US
Mailing Address - Phone:210-494-3739
Mailing Address - Fax:210-494-4508
Practice Address - Street 1:4118 POND HILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1281
Practice Address - Country:US
Practice Address - Phone:210-494-3739
Practice Address - Fax:210-494-4508
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7942207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3450Medicare Oscar/Certification
TXH58350Medicare UPIN