Provider Demographics
NPI:1518962851
Name:WELCH, WADE B (MD)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:B
Last Name:WELCH
Suffix:
Gender:M
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:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-270-7646
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:STE 420
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-295-7878
Practice Address - Fax:785-234-6301
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-243262084N0400X, 2084N0600X
MO20070187242084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100143760BMedicaid
KSF54939Medicare UPIN
KS130026302Medicare ID - Type UnspecifiedPALMETTO MEDICARE ID
KSF54939Medicare UPIN