Provider Demographics
NPI:1760721567
Name:WEICHELT, ADAM D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:D
Last Name:WEICHELT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:415 JEFFERSON ST NORTH
Mailing Address - Street 2:TRI-COUNTY HOSPITAL
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1296
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:218-631-7507
Practice Address - Street 1:415 JEFFERSON ST NORTH
Practice Address - Street 2:TRI-COUNTY HEALTH CARE
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1296
Practice Address - Country:US
Practice Address - Phone:218-631-3510
Practice Address - Fax:218-631-7507
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1870363AM0700X, 363AS0400X
MN11301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical