Healthcare Provider Details

I. General information

NPI: 1174484745
Provider Name (Legal Business Name): PENTUS HEALTH WYLIE LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 WYLIE DR
NORMAL IL
61761-5405
US

IV. Provider business mailing address

2273 LEE RD
WINTER PARK FL
32789-7217
US

V. Phone/Fax

Practice location:
  • Phone: 844-973-6887
  • Fax:
Mailing address:
  • Phone: 844-973-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IVAN REYES
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 407-756-3474