Provider Demographics
NPI:1942413257
Name:DAVID M WELLIKOFF D.P.M.
Entity Type:Organization
Organization Name:DAVID M WELLIKOFF D.P.M.
Other - Org Name:YAMHILL COUNTY FOOT HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-472-3341
Mailing Address - Street 1:1133 SW BAKER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6830
Mailing Address - Country:US
Mailing Address - Phone:503-472-3341
Mailing Address - Fax:
Practice Address - Street 1:1133 SW BAKER ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6830
Practice Address - Country:US
Practice Address - Phone:503-472-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00109213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCPCZAMedicare PIN
OR0856870001Medicare NSC