Provider Demographics
NPI:1942264627
Name:WELL, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 ARKANSAS ST
Mailing Address - Street 2:STE. 205
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-749-0639
Mailing Address - Fax:785-749-0991
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:STE. 205
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-749-0639
Practice Address - Fax:785-749-0991
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0415801208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082330BMedicaid
KS100082330BMedicaid