Provider Demographics
NPI:1407013527
Name:WELLIKOFF, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WELLIKOFF
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 1:5401 S CONGRESS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6637
Mailing Address - Country:US
Mailing Address - Phone:561-967-4118
Mailing Address - Fax:561-967-3463
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:STE 204
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-967-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124151207RP1001X, 207RP1001X
LA202351207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKW826OtherMEDICARE
LA4Q410F600OtherMEDICARE - PTAN