Individual
GORDON DANIEL WELK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
(765) 446-7023
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01025175A
IN
207Q00000X
Family Medicine Physician
01025175A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189493
UC ANTHEM PROVIDER NUMBER
IN
01
—
000000341035
FP ANTHEM PROVIDER NUMBER
IN
05
—
100117190
—
IN
01
—
10826167
CAQH NUMBER
IN
01
—
9038773
PHCS PID NUMBER
IN
Enumeration date
03/21/2006
Last updated
02/22/2016
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