Provider Demographics
NPI:1336639046
Name:WELLCARE MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:WELLCARE MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:OERTELL
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-720-9313
Mailing Address - Street 1:26355 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6210
Mailing Address - Country:US
Mailing Address - Phone:312-720-9313
Mailing Address - Fax:866-271-1135
Practice Address - Street 1:241 N SUPERIOR ST STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1253
Practice Address - Country:US
Practice Address - Phone:419-214-3220
Practice Address - Fax:419-214-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center