Provider Demographics
NPI:1124008339
Name:WELCH, STANLEY W (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 MEADOW VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7669
Mailing Address - Country:US
Mailing Address - Phone:608-334-4259
Mailing Address - Fax:608-245-1436
Practice Address - Street 1:4010 MEADOW VALLEY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7669
Practice Address - Country:US
Practice Address - Phone:608-334-4259
Practice Address - Fax:608-245-1436
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40563207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32537000Medicaid
F41627Medicare UPIN
WI32537000Medicaid