Organization
WELL CARE MEDICAL GROUP LLC
Active
Organization
WELL CARE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAE LUECK (CEO)
(747) 273-6179
Entity
Organization
Contact information
Practice address
6330 MCLEOD DR STE 3, LAS VEGAS, NV 89120-4431
(747) 273-6179
Mailing address
7488 W SAHARA AVE, LAS VEGAS, NV 89117-2740
(702) 641-1240
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NV
208D00000X
General Practice Physician
—
NV
261QM1300X
Multi-Specialty Clinic/Center
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073049367
—
NV
Enumeration date
05/04/2017
Last updated
01/28/2021
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