Provider Demographics
NPI:1912154097
Name:WELK, STEPHEN W (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:WELK
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 1:11829 MATTESON CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9639
Mailing Address - Country:US
Mailing Address - Phone:716-496-7440
Mailing Address - Fax:
Practice Address - Street 1:11829 MATTESON CORNERS RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9639
Practice Address - Country:US
Practice Address - Phone:716-496-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine