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NPI Code Detail

MEDICARE: STELLAR HEALTH & WELLNESS CLINIC LLC

MEDICARE: STELLAR HEALTH & WELLNESS CLINIC LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1952166423
Entity Type Code : Organization
Provider Name (Legal Business Name) : STELLAR HEALTH & WELLNESS CLINIC LLC
Provider Business Mailing Address
First Line : 1007 MEADOWSWEET DR
Second Line :
City : ENGLEWOOD
State : OH
Zip : 45315-7718
Country : US
Telephone Number : 937-750-5309
Fax Number :
Provider Business Practice Location Address
First Line : 5957 CLEVELAND AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43231-2210
Country : US
Telephone Number : 614-394-8092
Fax Number : 614-394-8078
Authorized Official
Title or Position : CEO
Name : MR. FIDELIS N ELOKOBI
Credential : APRN-CNP
Telephone Number : 419-779-4854
Provider Enumeration Date : 02/14/2024
Last Update Date : 11/20/2024

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Directions to “STELLAR HEALTH & WELLNESS CLINIC LLC ” Practice Location

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