Provider Demographics
NPI:1013998731
Name:WELSH, ROBERT K (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:WELSH
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 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1862
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:3577 W 13 MILE RD STE 301
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-0669
Practice Address - Fax:248-551-0058
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405374208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI294552010Medicaid
MI103360635Medicaid
MI330F373770OtherBLUE CROSS BLUE SHIELD
F54702Medicare UPIN
0630895Medicare ID - Type Unspecified
MI103360635Medicaid