Provider Demographics
NPI:1992892269
Name:WELLS, PATRICIA A (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 INDUSTRIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1741
Mailing Address - Country:US
Mailing Address - Phone:734-944-8000
Mailing Address - Fax:734-944-8008
Practice Address - Street 1:1235 INDUSTRIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1741
Practice Address - Country:US
Practice Address - Phone:734-944-8000
Practice Address - Fax:734-944-8008
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI062273207PE0004X
MI4301062273207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPW062273OtherBLUE SHIELD
MI104442341Medicaid
MI104442341Medicaid