Provider Demographics
NPI:1467774984
Name:WELLS, ANTHONY JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:WELLS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE G02
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-6650
Mailing Address - Fax:517-913-6677
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE G02
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-6650
Practice Address - Fax:517-913-6677
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1058901OtherMCLAREN HEALTH PLAN-MEDICAID
MI0653303520OtherBLUE CROSS BLUE SHIELD
MI0N61290015OtherMEDICARE PLUS BLUE/MEDICARE ADVANTAGE
MI1058901OtherMCLAREN HEALTH ADVANTAGE
MIP00833807OtherRAILROAD MEDICARE
MI1058901OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI9073520OtherAETNA
MIN61290015Medicare PIN