Provider Demographics
NPI:1538404991
Name:MARK ALAN WELLEK MD LTD
Entity type:Organization
Organization Name:MARK ALAN WELLEK MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WELLEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-955-1070
Mailing Address - Street 1:4202 N 32ND ST
Mailing Address - Street 2:STE G
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4746
Mailing Address - Country:US
Mailing Address - Phone:602-955-1070
Mailing Address - Fax:602-957-9614
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:STE G
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:602-955-1070
Practice Address - Fax:602-957-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-04601041C0700X
AZAZ64162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty