Provider Demographics
NPI:1215045885
Name:WELSH, JENNIFER L (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WELSH
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 1:1151 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6324
Mailing Address - Country:US
Mailing Address - Phone:612-706-4500
Mailing Address - Fax:612-781-6830
Practice Address - Street 1:1151 SILVER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6324
Practice Address - Country:US
Practice Address - Phone:612-706-4500
Practice Address - Fax:612-781-6830
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39275207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0556696Medicaid
MN1017646OtherPREFERRED ONE NUMBER
MN796807OtherAMERICA'S PPO
MN10G23WEOtherBCBS MN
MNHP27176OtherHEALTHPARTNERS NUMBER
MN112848OtherUCARE
WI32599600Medicaid
MN01-16224OtherMEDICA CHOICE & DUAL
MN602879900Medicaid
IA0556696Medicaid
MN112848OtherUCARE