Provider Demographics
NPI:1861541963
Name:WELCH, MONA C (DPM)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:C
Last Name:WELCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:STE 19
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3404
Mailing Address - Country:US
Mailing Address - Phone:941-795-4065
Mailing Address - Fax:941-795-4073
Practice Address - Street 1:501 VILLAGE GREEN PKWY
Practice Address - Street 2:STE 19
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3404
Practice Address - Country:US
Practice Address - Phone:941-795-4065
Practice Address - Fax:941-795-4073
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340609100Medicaid
FLU72909Medicare UPIN
5578750001Medicare NSC
FL65578AMedicare PIN