Individual
MATTHEW WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1033 N INDIANA AVE, SYRACUSE, IN 46567-1017
(574) 457-5701
Mailing address
1033 N INDIANA AVE, SYRACUSE, IN 46567-1017
(574) 457-5701
(574) 457-5609
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01082730A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300002815
—
IN
Enumeration date
06/19/2017
Last updated
03/18/2024
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