Provider Demographics
NPI:1093275505
Name:WELLS, JOSEPH RUSSELL LEE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RUSSELL LEE
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W. MICHIGAN ST
Mailing Address - Street 2:FESLER HALL 204
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-274-4343
Mailing Address - Fax:317-274-0256
Practice Address - Street 1:1130 W. MICHIGAN ST
Practice Address - Street 2:FESLER HALL 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-274-4343
Practice Address - Fax:317-274-0256
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01089967A390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program