Provider Demographics
NPI:1508844812
Name:WELLS, KENNETH W (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:WELLS
Suffix:
Gender:
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-0271
Mailing Address - Country:US
Mailing Address - Phone:330-923-7066
Mailing Address - Fax:330-923-8090
Practice Address - Street 1:95 ARCH ST STE 175
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1489
Practice Address - Country:US
Practice Address - Phone:330-375-6590
Practice Address - Fax:330-375-6593
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350605152083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822471Medicaid
E87005Medicare UPIN
OH0822471Medicaid
0693165Medicare PIN
0693166Medicare PIN