Individual
DR. LARRY L WELLENDORF II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2236 N MERRITT CREEK LOOP STE A, COEUR D ALENE, ID 83814-4960
(208) 625-3670
(208) 625-3675
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5084
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036091551
IL
207Q00000X
Family Medicine Physician
Primary
MC-2626
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091551
—
IL
Enumeration date
08/14/2006
Last updated
07/25/2025
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