Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 510105793 | MI |
N | 111NI0900X | Internist | 510105793 | MI |
Y | 207RH0002X | Hospice and Palliative Medicine | 5101015793 | MI |
N | 208000000X | Pediatrician | 510105793 | MI |
NPI | 1063601250 |
---|---|
Provider Name | Dr. Todd Craig Welton |
First Address | Kalamazoo, MI 49007-3899 |
Second Address | Kalamazoo, MI 49007-3899 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063601250 | (05) | MI |
1417961137 | BCBSM - BRONSON (01) | MI |