Healthcare Provider Details

I. General information

NPI: 1235793357
Provider Name (Legal Business Name): WELLCARE MED GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14261 COMMERCE WAY STE 203
MIAMI LAKES FL
33016-1647
US

IV. Provider business mailing address

14261 COMMERCE WAY STE 203
MIAMI LAKES FL
33016-1647
US

V. Phone/Fax

Practice location:
  • Phone: 305-698-4000
  • Fax: 305-698-4014
Mailing address:
  • Phone: 305-698-4000
  • Fax: 305-698-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: BASHAR A MOHSEN
Title or Position: OWNER
Credential: MD
Phone: 305-698-4000