Provider Demographics
NPI:1750536918
Name:WELCH, MITCHAEL GORDON
Entity type:Individual
Prefix:MR
First Name:MITCHAEL
Middle Name:GORDON
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 ABERDEEN AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-2856
Mailing Address - Country:US
Mailing Address - Phone:512-299-7286
Mailing Address - Fax:
Practice Address - Street 1:862 ABERDEEN AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2856
Practice Address - Country:US
Practice Address - Phone:512-299-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2025088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist