Provider Demographics
NPI:1124394663
Name:WELLS, EDEN VICTORIA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:VICTORIA
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S GRAND AVE
Mailing Address - Street 2:4TH FLOOR MDHHS
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-2108
Mailing Address - Country:US
Mailing Address - Phone:517-284-4020
Mailing Address - Fax:
Practice Address - Street 1:333 S GRAND AVE
Practice Address - Street 2:4TH FLOOR MDHHS
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-2108
Practice Address - Country:US
Practice Address - Phone:517-284-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010802772083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine