Provider Demographics
NPI:1790787067
Name:WELLS, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WELLS
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 1:6100 WINDHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8046
Mailing Address - Country:US
Mailing Address - Phone:972-378-0620
Mailing Address - Fax:972-378-0630
Practice Address - Street 1:6100 WINDHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-378-0620
Practice Address - Fax:972-378-0630
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2052207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201032275Medicaid
TX143174401Medicaid
84412ZOtherHMO BLUE
TX143174403Medicaid
TX126640100Medicaid
A491OtherTRIWEST
NM201032275OtherPRESBYTERIAN COMMERCIAL
TX80582SOtherBC/BS
NME3288Medicaid
OK100072980AMedicaid
TX126640101OtherFIRSTCARE COMMERCIAL
TX143174403Medicaid
TX80582SOtherBC/BS
A491OtherTRIWEST
NME3288Medicaid