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Organization

WELLINGTON PROVIDER GROUP PC

Active
Parent organization
WELLINGTON PROVIDER GROUP PC
Organization subpart
Yes

Provider details

NPI number
Legal business name
WELLINGTON PROVIDER GROUP PC
Authorized official
MARIELA BRAVO (CREDENTIALING SPECIALIST)
(859) 518-8817
Entity
Organization

Contact information

Practice address
1433 N WATER ST STE 400, MILWAUKEE, WI 53202-2603
(859) 518-8817
(859) 201-1084
Mailing address
535 WELLINGTON WAY STE 330, LEXINGTON, KY 40503-1331
(859) 518-8817
(859) 201-1084

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
02/06/2023
Last updated
02/06/2023
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